Almost one-third of organizations don't pay for inoculations: Report
In Canada, there is no obligation for provinces, territories, federal governments, or private payers to cover adult vaccines that have been recommended by the National Advisory Committee on Immunization (NACI).
Consequently, the availability of vaccine coverage across Canada is patchy and inconsistent for certain diseases.
But the World Health Organization (WHO) states that immunization is the foundation of the primary health care system and one of the best health investments money can buy.
The inaugural Private Drug Plan Leadership: Vaccine Coverage Report Card was developed to highlight benefits providers with modernized drug plan policies that include vaccines as a standard inclusion.
Wide gaps in coverage
Yet, despite tremendous progress, far too many people around the world have insufficient access to vaccines.
In Canada, access to and funding of vaccines is comprised of a complex mix of provincial/territorial public health programs, private payer plans, and out-of-pocket cash. While many vaccines are available in Canada for both children and adults, the success of vaccine uptake and adherence to immunization guidelines seen in children has not been observed among adult Canadians.
In 2022, Canadian insurers paid out a record $114 billion in benefits – up $11 billion from pre-pandemic levels. This included nearly $44 billion in health benefits, of which $14.3 billion was paid on prescription drug claims.
However, research conducted by Mapol has shown 32% of private payer plan members do not have coverage for vaccines, and 31% of private payer vaccine prescription claims are rejected.
“Vaccination is a safe and effective way of protecting your workforce (and their family members) against harmful diseases before they contract them. I challenge plan sponsors, advisors, and plan providers to make non-publicly funded vaccines a mandatory and normal part of all private payer drug plans,” says Gordon R. Hart, Selectpath Benefits & Financial.
“The inconsequential increase in claims cost for meaningful vaccine coverage is eclipsed by the economic and social cost of preventable illness and recovery.”
Mapol worked with industry experts in group benefits and personal health insurance policies to develop the report card. The goal of this research, on the group benefits side, was to identify what drug plan design would be offered to a potential plan sponsor with no previous history.
