IQVIA Study Highlights the Importance of Adult Vaccination in the US

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Despite their overall health benefits, US adult vaccination rates remain alarmingly low, especially among those enrolled in Medicaid programs, according to a report published by IQVIA. The investigators found that rates for the flu vaccine in this group are nearly 8%-10% lower than the general population, with that rate increasing to 30% when compared to individuals with Medicare coverage. Historically, Medicare payouts to vaccine providers have been substantially higher than Medicaid. As a result, the authors aimed to understand the correlation between vaccine uptake among the adult Medicaid populations and levels of reimbursement.

To conduct the research and find the appropriate answers, researchers relied upon a combination of the following:

• Data collection from multiple sources such as IQVIA, LRx, Dx, and claims data from the 2022-2023 flu season.
• Calculating total reimbursement amounts for Medicaid fee-for-service populations based on the specific reimbursement rates for vaccine administration.
• A comparison of reimbursement rates for vaccination by physicians under Medicaid and Medicare for financial purposes.
• Comparing the relationship between amount paid from Medicaid and overall influenza vaccination rates among adult patients.

Overall, results found that adult vaccination rates for influenza within adult Medicaid populations where disturbingly low. As a result, the team of researchers stressed the importance of strengthening vaccination coverage for this group of people. Additionally, access to vaccination sites was a major factor, with certain demographics, such as the Hispanic community, found to have less access to pharmacies. The results also found that higher payments from Medicaid resulted in more patients receiving vaccinations.¹

“While this regression highlights the relationship between reimbursement and vaccination rate, it should be noted that this is a correlation, and other factors impact the vaccination rate. While increasing the reimbursement rate for pharmacies may be one driver of vaccination, it may not be sufficient for enhancing the vaccination rate beyond a certain level. Such increases in payment must be done in collaboration with other efforts, such as increased education and outreach and greater access,” explained the study authors.

Going forward, the study authors suggest that in order to increase US vaccination rates, Medicaid programs must raise reimbursement levels to pharmacists. While acknowledging that this would lead to short-term cost increases, the authors insist that the long-term benefits include increased vaccination rates, reduced hospitalizations, and improved health outcomes. They also mentioned that it would help with health equity levels among minority populations as a result.¹

“Appropriate reimbursement to all healthcare professionals for immunizations and related administration services that provides necessary and equitable payment would encourage ongoing provision of these services,” the authors wrote. “Raising reimbursement levels may lead to short term cost increases, however, the anticipated increase in vaccination rates, reduction in hospitalizations, and avoidance of serious healthcare complications should offset these costs over time. It will continue to be important to address barriers to vaccination to help facilitate an increase in vaccination rates for adults in Medicaid. Raising reimbursement levels may not be sufficient on its own for increasing the vaccination rate but this study suggests that it is an important contributor to this process.”

Last June, the Centers for Medicare & Medicaid Services (CMS) notified state Medicaid agencies that at the beginning of October 2023, Medicaid and the Children’s Health Insurance Program will now be required to provide coverage and payment for approved adult vaccines recommended by the Advisory Committee on Immunization Practices without cost sharing, resulting from the Inflation Reduction Act.²

“Vaccination rates are suboptimal for all adults, regardless of health coverage, but for adults enrolled in Medicaid, the vaccination rates for a range of vaccinations are lower than for adults with private health insurance coverage, including influenza, tetanus, herpes zoster, hepatitis A, hepatitis B, and HPV vaccinations,” said Daniel Tsai, deputy administrator, director, CMS, in the letter. “Additionally, the COVID-19 public health emergency (PHE) had a negative impact on the rate of children receiving routine childhood vaccinations. Although child vaccination rates have rebounded since the beginning of the COVID-19 PHE, there is still a gap in child vaccinations compared to prior years.”

References

1. Trends in Adult Vaccination in the U.S. IQVIA. February 27, 2024. Accessed February 27, 2024. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/trends-in-adult-vaccination-in-the-us#:~:text=However%2C%20adult%20vaccination%20rates%20generally,witness%20disproportionately%20low%20vaccination%20rates.

2. Mandatory Medicaid and Children’s Health Insurance Program Coverage of Adult Vaccinations under the Inflation Reduction Act. Medicaid.gov. June 27, 2023. Accessed February 27, 2024. https://www.medicaid.gov/sites/default/files/2023-12/sho23003.pdf