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.