Behaviour Change, Vaccines and their Place in Group Benefits Coverage

Woman getting vaccinated at home during pandemic.

In our April 27th BPHA at Lunch webinar, presenters addressed the changing vaccine environment. Presenters included Dr. Jia Hu, physician and co-founder of 19 To Zero, and Pavithra Ravinatarajan, consulting pharmacist and product director at Manulife Financial.

Dr. Jia Hu provided an overview of the gap between which adult vaccines are recommended, and those that are covered publicly. The National Advisory Committee on Immunization (NACI) provides recommendations for vaccines on both an individual and public level, however public coverage of vaccines is determined individually by province/territories and therefore coverage can often differ across the country. Many vaccines that are strongly recommended for adults are not publicly covered, with Canadians paying out of pocket or relying on private coverage for access to these vaccines. This issue will become more prevalent in the future because of the number of vaccines in development, particularly for cancer and infectious diseases.

According to Pavithra Ravinatarajan, plan sponsors should examine their priorities and objectives when considering vaccinate coverage. Some group plans exclude coverage for vaccines because they are classified as ‘lifestyle’ drugs and/or because they are ‘preventative’. This may be in contrast with plan sponsor priorities for wellness programs and coverage additions according to results from the most recent Benefits Canada survey. With low adult vaccination rates (3% of Canadian adults have received all the vaccinations recommended for their age and risk group), workplace vaccine education and improved coverage for vaccinations is needed.

More on vaccine preventable diseases and vaccines:

  • Vaccine preventable diseases can be costly in claims for prescription medication, absenteeism and presenteeism. According to one 2012 study on employment related productivity as it relates to the shingles virus:
    • 64% of patients had to miss work due to shingles
    • 76% had reported decreased productivity at work.
  • Public coverage for adult vaccinations is inadequate and private coverage is critical to ensure access. Public coverage limitations are more often the rule rather than the exception. As an example, while NACI’s recommends Shingrix, the vaccine for shingles, for everyone 50+ and those under 50 who are immunocompromised, only adults aged 65-70 are publicly covered in Ontario and most other provinces do not provide any public coverage.
  • The gap between vaccines that are recommended and those that are publicly covered is likely to grow given the increased rate of vaccine development. There are currently over 260 vaccines in the development pipeline.

What attendees told us:

The case for adding coverage for vaccines in benefit plans is clearly compelling. Here are just some of the top take aways attendees listed in their evaluations:

  • “Most adults are not aware of gaps in coverage”
  • “Shingles is not just for older age adults”
  • “Prevention is less costly and less painful than the cure”
  • “Not many [adults] are fully vaccinated”
  • “There needs to be more education around the benefits plans and vaccines for both plan sponsors and members”
  • “Private plans help cover the gaps between what is publicly covered and what is recommended”
  • “Including vaccines is a proactive approach to benefit plans”

This webinar successfully highlighted the increasingly important need to address access to vaccines within private plans. The COVID-19 pandemic and its aftermath have accelerated the need to protect and retain existing employee populations. This, combined with the growing gap between public coverage and recommended vaccinations, means that private plans have an opportunity to provide preventative care to employees who need it the most.

Thank you to our speakers for sharing their insights and to all who attended. If you missed it, you can view the recorded webinar here.