Healthcare Providers Stay the Course on Vaccines

The Trump administration has provided mixed messaging regarding vaccine policy. What are employers and insurers planning in the early days of these vaccine changes?

LEE: ACIP has come out with different guidance than before on COVID-19 vaccines, which means insurers now have the option to decide in some cases whether they want to implement cost sharing for non-high-risk populations. But what we have found in our member plans is they are basically staying the course. Our members are really committed to disease prevention and health promotion, and we’ve had discussions with them about vaccines and this is not a difficult decision for them. They see vaccines as being very cost-effective. It’s good medicine. They will continually monitor the scientific evidence around the vaccines that are being discussed, but, to date, they are planning to keep their current policies they have for coverage as it pertains to COVID-19 and MMR and all of that.

GREMMINGER: What we are seeing is employers who are just going to cover what there is now. The read I have, just talking to employers in our coalition, is the last thing they want to do is be out there by themselves picking and choosing, because it could open them up to employee satisfaction and retention issues. Employees would be asking why their employer is covering one thing [in one state] and not in another. You could see a world in which people get litigious.

Would insurers or employers use the new recommendations to reduce some preventive services as a cost-cutting measure?

GREMMINGER: Between one-half [percent] and 1% of all covered lives account for between 40% and 50% of employers’ costs. If you expand it out, 5% of covered lives account for more than 80% of our costs. And employers are actively looking for ways to bring costs down. But the place to do that is for very expensive procedures and very expensive drugs. Vaccines are not expensive and covering vaccines is proven to be effective. So, most employers would say, “I’d rather pay for the vaccine up front and have fewer people get the flu, COVID-19, or significant childhood diseases.” That’s going to end up saving money.

But COVID vaccines are significantly higher priced than they used to be. Today, if everyone in a company gets one, they are about $200, which isn’t an insignificant cost. But I still think most employers are going to cover them because if you can reduce the amount of people in your workforce that have COVID by 50%, that’s huge savings in terms of reduced hospitalizations and absenteeism. I think most employers have decided to cover them, recommend people get them, and not push beyond that to require the vaccine.

If these firings continue or, say, the USPSTF changes recommendations at some point, where do insurers and employers go for a single source of truth? Will they look to groups like the American Academy of Pediatrics or the American Medical Association for recommendations?

GREMMINGER: People are spending a lot of time talking about the impact of these changes and how they might erode trust in government sources for patients, and the same can be said for employers. We rely on the recommendations of these organizations to set our benefit packages, and particularly on something like vaccines, which has, until COVID, always been kind of easy to decide. But these changes have made our lives significantly harder. Employers, especially self-insured employers, have a lot of flexibility in terms of what they choose to cover and under what circumstances. And that flexibility is generally the thing that drives towards better value, by covering things like vaccines, which are obviously effective. And the USPSTF actually has a significant role in deciding what we are allowed to cover. Not having that trust means that…employers have to figure it out on their own now.

LEE: We are trying to educate members and partner with providers to answer questions for those who are concerned and clarify on the notion of shared decision-making that is supposed to be used for COVID vaccines. One of the benefits for many of our members is they are part of a larger integrated system so they can synchronize their messaging and coordinate their communications more effectively with physicians and their members. The main strategy now, across the board, is trying to not put any new burdens in front of people to keep them from getting vaccinated.

Our members are going to do the right thing when it comes to health promotion and disease prevention. The uncertainty just makes it more complicated, because the Preventive Services Task Force and ACIP guidelines are helpful to set a standard of coverage, so when they change, or when they’re not there, members will have to look elsewhere. And I think that is happening now to some extent—looking towards medical societies and other professional guidelines. It made it simpler to put out a standard of guidance for coverage. But in the absence of that, or with doubt about the soundness behind the guidance, they’ll continue to look at other sources and maybe weigh those more heavily than before.

Some states are providing their own vaccine recommendations. States in the West and Northeast have formed health alliances to give recommendations. Conversely, Florida is considering canceling its vaccine requirements. Does that muddy the waters for employers and insurers?

GREMMINGER: I understand why states are doing that but think it’s not helpful. It further complicates the conversation. It makes it even harder for employers to know what the right answer is. If you are an employer based in California but have offices in other states, are you going to offer different benefit packages as it relates to vaccine access to your employees in Texas? That’s kind of dodgy. It’s so much better to have a national standard.

LEE: It makes things more complex because our plans have to follow the federal laws as well as the state laws in which they operate. When federal guidelines step back or make things optional and states go a different direction, it makes the landscape more complicated.

You know, science is still science. Insurers have their internal processes for evaluating and making coverage decisions for any medication or new therapy. That’s what they’re relying on, just going back to the evidence and the science. And then, of course, making sure that they’re really investing in what they think is going to bring the most health for each premium dollar.

Much of healthcare has tried to shift to preventive care to avoid larger downstream health complications and expenses. Could this be complicated if the new committees claw back federal guidelines for these treatments?

LEE: We’ll have to see what happens. I reached out to member plans after the last round of changes, and one chief medical officer told me this isn’t a hard decision for them. Our member plans are committed to prevention and preventive care.

Are there other concerns regarding changes in vaccine policy or confusion with recommendations?

LEE: I think one thing all of our member plans are worried about is the impact changing federal guidance will have on public vaccine uptake. So many of our members have said the consequences of all of this is that vaccine hesitancy will increase and that vaccination rates will drop for the vaccines that federal policymakers or federal advisory committee members are voicing concerns about. That definitely causes concern.

I still practice medicine and see patients, and the Tylenol announcement sowed a lot of concern. [Kennedy in October stated his belief in a potential connection between women who use Tylenol during pregnancy and children with autism but later admitted he did not have evidence to prove the link exists.] So, what that meant was spending a lot of time with each patient, especially parents, to explain whether they are at risk or not. Some of my own family members were telling me they would have to get a prescription before they get a COVID vaccine, and I told them they could just go to the pharmacy like they did before. That’s an example of how, across the board, people are hearing bits and pieces of these things and then their health decisions aren’t clear.

Are either of your organizations helping members promote vaccine uptake and preventive care services during this time of uncertainty and mixed messaging from government agencies?

GREMMINGER: I was at a conference a couple of weeks ago where we talked about how to create better messaging around vaccines, in particular for parents who are vaccine-hesitant. The healthcare system has done a really poor job of it. If you tell a parent who is trying to do what they think is the right thing that they aren’t smart or are jeopardizing the health of their child, that’s obviously an incredibly ineffective message.

The right messengers here are clinicians and pediatricians. If there is one thing we can take away from the COVID experience, it’s that most people don’t want their employer talking about this. Employers can encourage members to get their kids and themselves immunized, communicate very broadly that vaccines are free or inexpensive, let them know where to get them, and maybe offer credible resources put out by groups like the American Academy of Pediatrics.

HR directors or benefits directors aren’t necessarily seen as a credible voice in this debate, and employers are trying to avoid the limelight or being on the wrong side of this issue. We’ve been in conversations with some of the medical societies and insurance carriers, and there is this idea that they are going to stay away from this controversial issue. That certainly works this year, but I don’t know how much longer it’s going to last—especially with how much press there is around what is being said and done regarding vaccines.