Report Finds Link Between Pharmacy Reimbursement and Flu Vaccination Rates for Medicaid-Covered Adults

The Global Healthy Living Foundation (GHLF) and the IQVIA Institute for Human Data Science recently co-released a report that found a link between pharmacy reimbursement and flu vaccination rates among Medicaid-covered adults in the United States. GHLF and IQVIA Institute for Human Data Science commissioned the report to better understand the correlation between equitable compensation for pharmacists and enhanced vaccination rates for the adult Medicaid population.

The report notes that adult Medicaid beneficiaries tend to face “significant disparities in vaccination rates” when compared to individuals with Medicare or commercial insurance coverage. Prior studies have found an 8-11% gap in flu vaccination rates between Medicaid and commercial insurance populations and a nearly 30% difference between Medicaid and Medicare populations.

This may be due in part to the fact that, as the report notes, “Medicare payments to vaccine providers are uniformly higher than Medicaid payments.” According to a 2023 survey published in Health Affairs, Medicare reimbursement for flu vaccines administered by physicians was $30, but 38 state Medicaid programs paid physicians less than $15 for administering the same adult flu vaccine.

The report pulled state-level provider reimbursement data for flu vaccine supply and administration for Medicaid fee-for-service populations as well as state-level flu vaccination rates in those patient populations, and then reviewed the relationship between the two variables.

Additionally, the total reimbursement amount was estimated for each state for office-based physicians and for pharmacies, using publicly available materials related to Medicaid coverage and reimbursement policies for influenza vaccines for adults in all 50 states, plus the District of Columbia. The total reimbursement amount consists of a fee for the vaccine supply as well as a fee for the vaccine administration. For office-based providers, vaccine reimbursement may also include a fee for a billable office visit. The estimated cost of the vaccine was subtracted from the total fees to calculate the estimated total reimbursement amount.

Overall, the report found that the state level Medicaid fee-for-service Influenza Vaccination Rate generally ranges from 10% to 30%, with a few outlier exceptions. The estimated total reimbursement amount for physicians and pharmacies varies across states. In the case of pharmacies, this ranges from a reimbursement amount that is lower than the cost of the vaccine supply to a total reimbursement amount of roughly $25. The average reimbursement amount for pharmacies across states is roughly $12. For office-based physicians, the average is around $22.50.

The report also found that the estimated total reimbursement amount for pharmacies is significantly and positively associated with the proportion of Medicaid fee-for-service population that received the flu vaccination for the 2022–2023 flu season at a state level, after controlling for other factors such as state per capita income, state education, and total reimbursement amount for providers.

Additionally, a $13 increase in Medicaid fee-for-service total pharmacy reimbursement amount for adult influenza vaccination supply and administration was associated with a 5.6% increase in the state vaccination rate for adult Medicaid fee-for-service population. For physician offices, however, total reimbursement amount was not significantly associated with influenza vaccine uptake in adults.

Similar results were found when restricting the analysis to only male or only female populations; when restricting the analysis to urban populations (not with rural populations, though); and for Hispanic, White, and Black populations (results not significant for Asian populations).

“Pharmacists play a crucial role in immunization efforts in the U.S. and globally; now is the time to ensure state policies adequately compensate pharmacies for vaccine administration,” said study co-author Robert Popovian, PharmD, Chief Science Policy Offer at the Global Healthy Living Foundation (GHLF). “These actions can be a crucial step toward improving vaccination rates for Medicaid enrollees.”

“The improved reimbursement for pharmacists to administer the flu vaccine for Medicaid patients is an essential step in addressing health disparities as it pertains to low-income communities where pharmacies are far more accessible than physician offices and where racial and ethnic minorities are overrepresented,” said Dr. Popovian.