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Changes to the seasonal influenza vaccine recommendations for 2017 – 2018

October 9, 2018

As the influenza season approaches, we want to remind providers that all Independence 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, Independence 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 Independence policies have been updated to reflect this change in coverage of FluMist? LAIV from not medically necessary to covered: 

Commercial
  • #08.01.04s: Immunizations
  • #00.06.02w: Preventive Care Services
Medicare Advantage
  • #MA08.007l: Medicare Part B vs. D Crossover Drugs
  • #MA00.003i: Preventive Care Services

Note: For Medicare Advantage products, FluMist? LAIV is covered as a preventive service for individuals ages 2 through 49 under Part B regardless of whether the vaccine is ordered by a doctor of medicine or osteopathy.

To view these policies, go to the Medical Policy Portal. Select Accept and Go to Medical Policy Online, then select Commercial or Medicare Advantage, depending on which version of the policy you would like to view, and then type the policy name or number in the Search field.


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