Should Your Benefits Plan Cover Vaccines?

Vaccines can provide important protection for your most vulnerable plan members, but should they be part of your benefits plan? And how can you offset the cost? Anar Dossa, Director of Pharmacy Services with Pacific Blue Cross, presented on this topic at our recent Trends in Health and Wellness virtual conference.

Should Your Benefits Plan Cover Vaccines?

Vaccines have been around for more than 200 years, and providing coverage through your benefits plan has advantages for plan sponsors and plan members alike, said Dossa.

Vaccines are needed for highly infectious diseases that have no treatment or cure available, as well as for diseases that reduce the quantity and quality of life, she explained. Measles, for example, is highly infectious: you can catch it from someone an hour after they sneeze and leave the room!

Even diseases that seem to have disappeared can reappear over time, due to lowered vaccination rates and increased international travel, Dossa added.

Are the COVID-19 vaccines safe?

As with any medical advancement, there are often concerns around the safety, efficacy and cost of vaccines. Given that it usually takes years to get vaccines approved, some may be wondering about whether the COVID-19 vaccines are safe, she noted.

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Dossa outlined the phases of vaccine development—from basic and preclinical research through to approval—explaining that even with the COVID-19 vaccines, Health Canada still requires all phases to be completed, but the phases may overlap. Additional guidance and oversight are provided through a global group called the Strategic Advisory Group of Experts on Immunization (SAGE), which advises the World Health Organization on vaccine safety, and the Coalition for Epidemic Preparedness Innovations (CEPI), a global partnership launched in 2017 to develop vaccines to stop future epidemics.

“If a vaccine is available on the market…it’s safer to get the vaccine than to get the disease,” she said, adding that a lot of work is being done now to prepare for possible future pandemics.

Protecting the herd

With any vaccine, there will always be a group of people for whom vaccination isn’t recommended. That’s why it’s important to ensure that enough people are vaccinated to protect them through “herd immunity”, Dossa explained.

Vaccine coverage is provincially mandated, but there are gaps—and coverage through private benefits plans plays a key role in filling those gaps, she continued. In particular, she suggested plan sponsors consider coverage for:

  • The pneumococcal vaccine, for those not eligible for publicly funded coverage;
  • The shingles vaccine (depending on the plan population, since shingles is more common in those over age 50 or the immunocompromised); and
  • Travel-related vaccines, as they can be very expensive.

She recommends plan sponsors talk to their pharmacy team or pharmacy benefit manager to find out what is already publicly available and how best to coordinate their benefits plans with that coverage.

[Related Reading: What Employers Need to Know About COVID-19 Vaccines and Return to Work]

Who’s going to pay for it?

With limited plan funds and budgets, cost may be an issue. But there are ways to offset the additional costs, said Dossa. For example, since every 1% increase in generic utilization in Canada saves about $600 million, why not consider generic pricing to offset the cost of including vaccines in your benefits plan?

“Until we can eradicate it globally, vaccines are very important,” she emphasized, adding that information about vaccines can change over time, so it’s vital to keep up with new developments.

Conclusion

Plan sponsors have an opportunity to provide vaccine coverage for their members to help guard against infectious diseases. There are ways to offset the cost, and as long as accurate scientific research supports their efficacy and safety, vaccines may provide a much-needed boost to protect the general population.  


Alyssa Hodder
Director, Education and Outreach – Canada

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