As the influenza season approaches, we want to remind providers that all
AmeriHealth plans cover a yearly influenza vaccine (commonly referred to as a
flu shot) during each year’s flu season. Coverage may be subject to
applicable deductible and coinsurance requirements; however, copayments should
not be collected for the vaccine or its administration.
On February 21, 2018, the Advisory Committee on Immunization Practices
(ACIP) recommended that FluMist? intranasal live attenuated
influenza vaccine (LAIV) be an option for influenza vaccination for individuals
ages 2 through 49. Note: This is a change from previous ACIP
recommendations.
Updated coverage position
Based on the change to ACIP’s recommendations, as of
September 3, 2018, AmeriHealth covers FluMist? LAIV
as a preventive service for individuals ages 2 through 49. This change was also
communicated on August 31, 2018, in the News & Announcements section of our
Medical Policy
Portal.
The following AmeriHealth medical policies have been updated to reflect this
change in coverage of FluMist? LAIV from not medically necessary to
covered:
- #08.01.04s: Immunizations
- #00.06.02w: Preventive Care Services
To view these policies, go to the Medical Policy
Portal. Select Accept and Go to Medical Policy Online, then select
Commercial Policies, and then type the policy name or number in the
Search field.