While vaccine coverage varies across provincial drug plans, several million Canadians who are members of private drug plans don’t have coverage at all, according to Chris Bonnett (pictured left), founder and principal consultant of H3 Consulting, during a panel session supported by GSK, Merck & Co. Inc. and Pfizer Canada Inc. at Benefits Canada’s 2022 Face to Face Drug Plan Management Forum in Toronto in December.
“Does that make sense for something that’s low cost, cost-effective and valuable?”
A lot of vaccines are recommended by the National Advisory Committee on Immunization, said Dr. Jia Hu (pictured middle), a member of the NACI and chief executive officer of non-profit 19 To Zero, also speaking on the panel. “Even though they are recommended, they aren’t necessarily funded.”
Since the NACI isn’t a payer, it’s up to individual provinces and territories to decide to cover vaccines once they’re approved and recommended, he said. “There are a lot of recommended vaccines that are not covered and a lot of variation between provincial and territorial coverage. Unlike medications being added to the formulary, there is no clear mechanism for vaccines to be funded — it is very ad hoc.
“One of the big challenges with vaccine funding is that it tends to come out of public health budgets, which are infinitesimally small compared to hospital or drug budgets. And, as long as that’s still the case, it will be very hard for vaccines to be funded. We want to change the mechanism by which vaccines get funded.”
Hu pointed to research that found the top three reasons for low vaccine uptake in Canada are related to cost — either the cost of the vaccine is too high, there’s no government funding or there’s a lack of private coverage.
“Vaccines are probably the single most important health intervention that we could fund,” said Frédéric Leblanc (pictured right), strategic leader in drug programs for group benefits and retirement solutions at iA Financial Group, also speaking on the panel.
While infections can have a huge impact on workplace and employee productivity, some conditions can be prevented cost-effectively with vaccines, he said, citing data that found 57 per cent of people affected with shingles reported an average of 9.1 days lost time from work, 66 per cent reported decreased work productivity and the potential vaccine cost was just $260.
Preventative treatments are often excluded from benefits contracts, said Leblanc, suggesting they need to evolve and modernize.
In iA’s book of business, 43 per cent of plan sponsors offer vaccine coverage and 64 per cent have a maximum for vaccines expenses. Since larger groups are more likely to cover vaccines, this represents 70 per cent of insured lives. This data aligns with the 2022 Benefits Canada Healthcare Survey, he noted, which found 45 per cent of benefits plan sponsors said they already covered vaccines and 25 per cent wanted to add coverage.
Among plan sponsors that have no limits to vaccine coverage, 5.5 per cent of members had a vaccine claim, which represents 1.66 per cent of drug claims cost, said Leblanc, sharing analysis of iA’s vaccine claims. Among plan sponsors with limits, 2.8 per cent of members had a vaccine claim, representing 1.43 per cent of drug claims expenses.
He also commented on the inconsistency of benefits coverage. If a plan member has cancer, for example, the plan will often cover disability claims, cancer treatment and, potentially, mental-health support. If the patient goes into remission, they may return to work, but will be immunocompromised. In a situation where the plan doesn’t cover vaccines, they’ll have paid for all of these benefits, but the plan member is even more susceptible to a vaccine preventable disease.
According to Leblanc, iA is considering including vaccines in standard benefits plans instead of allowing plan sponsors to opt in to vaccine coverage.
Read more coverage of the 2022 Face to Face Drug Plan Management Forum.