Reimbursement Programs Available for Adult Vaccines

1. Reimbursement Programs Available for Adult Vaccines Mey Phu, MPA Immunization Branch Maria Volk, MPA Immunization Branch Rachel McLean, MPH STD Control Branch

2. Tdap Expansion Program Background • Tdap Expansion Program • Short-term program • Funded with ARRA federal funds • Ended December 2010

3. AHVPBackground • Adult Hepatitis Vaccine Project • California Adult Viral Hepatitis Prevention Strategic Plan, 2010-2014 • Opportunities • Health reform implementation • Vaccine patient assistance programs

4. Adult Hepatitis Vaccine Project • HBV or combination HAV/HBV vaccine for LHJs and CBOs serving at-risk adults • Targeted Settings: • Primary care clinics, local health departments, STD clinics • HIV prevention & care programs • Drug treatment programs, jails, prisons • Clinics serving foreign-born individuals from countries with >2% endemic HBV, and their children • >100,000 doses administered in 2007-2010 • 250 sites • 12 clinics serving primarily Asian Americans and Pacific Islanders • Featured in CDC Morbidity and Mortality Weekly Report, May 7, 2010 • Funded by CDC time-limited cost-savings and federal 317 dollars; ended Sept. 2010

5. CA Adult Viral Hepatitis Prevention Strategic Plan – Strategic Directions Improving Surveillance Capacity and Data Use Educating the Public, Providers, and Policymakers Targeting and Integrating Services and Building Infrastructure SD 1 SD 2 SD 3

6. SD3: Targeting and Integrating Services and Building Infrastructure • Increase adult viral hepatitis (VH) counseling, testing, and health education capacity and services • Increase VH laboratory testing capacity • Increase adult VH vaccination capacity and delivery • Increase access to syringe exchange and other harm reduction services

7. Opportunities • Health reform • Expansion of Medicaid coverage for low-income adults • Creation of health insurance exchanges • HHS definition of “basic preventive services packages” • Some health plans must offer all immunizations recommended by Advisory Committee on Immunization Practices (ACIP) without a patient co-pay • Vaccine manufacturer patient assistance programs

8. Available Programs • eDispense (Merck) • Vaccine Patient Assistance Program (Merck) • Vaccines Access Program (GSK) • G.I.F.T. Program (sanofi pasteur)

9. eDispense (Merck)

10. eDispense (Merck) - About On-line Vaccine Manager tool for processing claims for adult vaccines under Medicare Part D plans, screens patient eligibility Patients sign vaccine administration log after administration Reimbursements made monthly Reimbursements varies by plan for each vaccine Admin fee included Payments can be directly deposited into bank account or $2.50 charge for payment by check

11. •Aetna • Excellus- All Part D Plans *ExpressScripts PBM including: • Affinity Health Plan • BCBS of LA • BCBS of MA • Chinese Community • Clear Choice • DakotaCare • Delaware Physicians Care Advantage • Express Scripts • Firstcare • Healthfirst of NJ • Health Choice of Arizona • Healthfirst, Inc. (Managed Health, Inc.) • Healthfirst of NJ • Medcore • Network Healthplan • Paramount Health Care – PDP • Rocky Mountain Health Plans • SCAN • Schaller Anderson of Delaware • Schaller Anderson of Maryland (Maryland Physicians Care) • Senior Whole World • Southwest Catholic Healthcare Network • DBA Mercy Care Plan • UPMC List of participating health plans https://www.vaccinesupportservices.com/pdf/payer_coverage/eDispense_Report.pdf

12. eDispense (Merck) - Enrollment Website: enroll.edispense.com No cost to enroll Can enroll multiple practice locations under one account NPI number required

13. eDispense (Merck) – Contact Info Check with your local Merck rep or Meg Dorsey Merck Senior Public Sector Manager (530) 320-5927

14. Vaccine Patient Assistance Program (Merck)

15. Vaccine Patient Assistance Program (Merck) - About Dose replacement program Quarterly replacement shipments Pre-filled syringes or vials Provides: GARDASIL® M-M-R® II PNEUMOVAX® 23 RECOMBIVAX HB® VAQTA® VARIVAX® ZOSTAVAX®

16. Vaccine Patient Assistance Program (Merck) – Provider Eligibility Criteria • Stocks Merck vaccines • Willing to screen patients according to Merck's eligibility criteria   • Willing to work with Merck's vendor to process patient applications • Potential auditing • Willing to accept fact that no vaccine administration fee is provided by Merck • Willing to keep individual immunization records

17. Vaccine Patient Assistance Program (Merck) – Patient Eligibility • Resident of U.S. • Age 19 or older • Have no health insurance coverage • Annual household income less than: -- $43,320 for individuals -- $58,280 for couples or -- $88,200 for a family of four

18. Vaccine Patient Assistance Program (Merck) – Enrollment • Each patient and their provider must fill out and fax application to Merck for approval assessment. • The application must be faxed and approved prior to administration of vaccine in order to qualify. • Merck guarantees a response within 10 minutes for each application. • Provider must submit additional applications for each subsequent dose.

19. Vaccine Patient Assistance Program (Merck) – Contact Info Merck – Vaccine Patient Assistance Program (800) 293-3881 Monday – Friday, 8:00 AM–8:00 PM EST

20. Vaccines Access Program (GSK)

21. Vaccine Access Program (GSK) - About Currently provides GlaxoSmithKline vaccines to adult Cervarix, Twinrix, Boostrix, Engerix-B and Havrix. Approval required for each patient. Each administered dose of vaccine, that has been approved, is automatically tracked by the program. Replacement vaccine is sent monthly. Prior to shipping the replenishment the program will call the prescriber’s office to confirm arrival date and address. Vaccine replacements are shipped temperature controlled for next day delivery. Replenishment is exact dose for dose given through the program. The GSK Vaccines Access Program does not cover administrative fees or other office visit fees.

22. Vaccine Access Program (GSK) - Enrollment Prior to enrolling patients, prescribers must register in the program online. http://www.gsk-vap.com/ Once the prescriber submits the requested information on-line, a notification will be returned online regarding acceptance into the program. The prescriber is assigned a registration number to be used when submitting the patient’s enrollment application.

23. Vaccine Access Program (GSK) - Patient Eligibility Criteria: Patients who meet the following criteria may be eligible for GSK Vaccines Access Program: The patient is an adult 19 years or older or a female between 19 and 25 for Cervarix. The patient has an annual household income less than or equal to 250% of the federal poverty level, adjusted by household size. Must be verified. The patient lives in one of the 50 states or the District of Columbia; and The patient has no third party coverage for vaccines.

24. Application Procedure for Patients • Application is needed for each eligible patient. • Participating providers helps patients complete an application then faxes the form, with proof of income, to the GSK Vaccines Access Program. A reply of acceptance or denial will be faxed back to the provider, usually within 10 minutes. • Once accepted into the program, patient is eligible to receive free GSK vaccine that is in the program for up to one year. • Prior to administering subsequent doses to an enrolled patient, the prescriber must complete and fax a Dosage Authorization Request Form.

25. Vaccines Access Program (GSK) -Contact Information: GSK Vaccine Access Program P.O. Box 18428 Louisville, KY 40218 Phone: 1-877-8222911 Fax: 1-877-822-1555 http://www.gsk-vap.com/ Marija Micic Vaccine Segment Account Manager, Public CA/HI Cell: 415-706-1209 cell GSK Voicemail: 800-496-3772 ext. 90942 marija.x.micic@gsk.com

26. G.I.F.T (sanofi pasteur)

27. G.I.F.T. (sanofi pasteur) - About • Grant program through AmeriCares and What to Expect foundations to provide free Tdap doses • sanofi pasteur will provide up to 75,000 doses of Adacel vaccine to approved public and community health facilities at no cost • Initial donation of 25,000 doses • Additional 1 dose donation per 100 doses ordered • To date, only 16,000 doses distributed through the program • Deadline is May 31, 2011

28. G.I.F.T. (sanofi pasteur) - Eligibility • Provider Eligibility • G.I.F.T. program targets community health centers that provides charitable medical services to populations <200% of U.S. poverty level • Patient Eligibility • For administration to uninsured mothers and family members of infants

29. G.I.F.T (sanofi pasteur) - Enrollment • Online application process at • www.WhatToExpect.com/application or • www.AmeriCares.org/dma/adacel • Application Includes: • General Information, • Clinic Demographics (including licensing information) • Implementation Activities • Tdap Needs

30. G.I.F.T. (sanofi pasteur) • If approved to receive Adacel • AmeriCares will contact you to assess your needs • sanofi pasteur will contact you prior to shipping • Your organization is eligible for on-going donations of medical and pharmaceutical supplies from AmeriCares

31. G.I.F.T. (sanofi pasteur) – Contact Information Morgan White, AmeriCares uspartnerships@americares.org 203-406-4429 Phone:  203-658-9567 OR AmeriCares 88 Hamilton Ave Stamford, CT 06902 203-658-9504 1-800-486-HELP Fax: 203-658-9604

32. Contact Information Mey Phu-CDPH Immunization Branch Mey.Phu@cdph.ca.gov Maria Volk-CDPH Immunization Branch Maria.Volk@cdph.ca.gov Rachel McLean-CDPH STD Branch Rachel.Mclean@cdph.ca.gov *Note: CDPH Immunization Branch does not endorse any of the companies or their products that are featured in this webinar.