Financing Influenza Vaccine Delivery In the U.S.: Barriers and Potential Solutions

Background: As recommendations for universal influenza vaccination have expanded to now include >300 million children and adults each year, vaccine delivery in non-medical settings is becoming increasingly important. 

Objectives: Our objective was to identify barriers to and solutions for expanding influenza vaccination in community settings.

Methods: We conducted semi-structured telephone interviews from 01/09 to 06/10 with a range of stakeholders involved in influenza vaccination, including health insurers, medical services firms, retail based clinics, pharmacies, schools, and state and local public health immunization programs. Participants (n=66) were asked about factors that impeded or facilitated their capacity to deliver influenza vaccines to children and adults in community settings. Key themes were identified through iterative coding using a grounded theory approach.

Results: Stakeholders identified specific barriers to optimal influenza vaccine delivery in 3 major areas:  purchase and distribution, delivery logistics, and reimbursement.  Limited purchasing power, the uncertain nature of public demand, and unpredictable timing of influenza vaccine supply were important barriers to enhancing delivery in community settings. Delivery logistics associated with running off-site clinics especially in school settings, the need to manage publicly vs. privately purchased vaccines separately, and state-to-state variability in requirements for credentialing, physician oversight and reporting were also cited as barriers.  Barriers to reimbursement included a protracted credentialing process, the need to determine insurance eligibility at point-of-service, and lack of a billing infrastructure in off-site clinics.  Opportunities to expand vaccination in community settings focused on coordination across providers and the role of public health as a “trusted broker” to overcome existing challenges.

Conclusions: Financial barriers to efficient purchasing and reimbursement hamper the optimal use of community settings to effectively deliver influenza vaccination. Public health officials and private and governmental health care payers are well-positioned to take the lead in creating and implementing coordinated solutions to overcome these barriers.