As a mumps disease outbreak has been reported at area schools, we want to remind providers about vaccine coverage for the prevention of this condition for AmeriHealth members.

In January 2018, the Advisory Committee on Immunization Practices (ACIP) recommended that people identified by public health authorities (e.g., local health department) as being part of a group at increased risk for acquiring mumps because of a mumps outbreak should receive a third dose of the measles, mumps, rubella vaccine (MMR) vaccine.

Our coverage is in alignment with this recommendation. AmeriHealth covers MMR as preventive, with $0 cost share, for “one dose of mumps-virus containing vaccine for individuals at least 12 months old who previously received a mumps-containing vaccine who are identified by the public health authorities to be at increased risk during a mumps outbreak.”

If you suspect an outbreak or are unsure whether your patient belongs to a group at increased risk, please contact your local health department.

More information

For more information, refer to the following AmeriHealth medical policies:

• #08.01.04t: Immunizations
• #00.06.02x: Preventive Care Services

To view these policies, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then type the policy name or number in the Search field.

If you have any questions after reviewing the medical policies, please call Customer Service at 1-888-YOUR-AH1 for AmeriHealth New Jersey or at 1-800-275-2583 for AmeriHealth Pennsylvania.