H1N1 and seasonal flu prevention for employers

How will the H1N1 vaccine be distributed and administered?

The vaccine is now becoming available in larger quantities and is being administered first to those who are most at risk. State governments in Oregon and Washington are working with the federal government to distribute the vaccine to each county. It is the county's responsibility to choose sites and partners to administer the vaccine. Members are advised to contact their local health departments or check the www.flu.oregon.gov or www.doh.wa.gov/H1N1 Web sites where information about distribution sites is now posted.

Who is being given priority for H1N1 vaccination?

• Everyone aged 6 months to 24 years
• Pregnant women
• People caring for or living with infants under 6 months of age
• People aged 25 to 64 with underlying medical conditions (such as asthma, immune deficiencies, etc.)
• Health care workers, emergency medical responders and front-line law enforcement and public-safety workers

How is the H1N1 vaccine covered?

The federal government is paying the cost of the serum. If the vaccine is administered by a county, state or federal employee or facility, then the copay is likely to be waived. Private-sector partners (such as clinics and pharmacies) may charge an immunization copay to administer the vaccine. Where required, a member will pay the same copay as for the seasonal flu vaccine (listed on benefit summaries under “immunizations”).

Are on-site H1N1 flu-shot clinics available?

No. The distribution of the vaccine through county health departments prioritizes those groups who are most at risk for serious complications. Members who are most at risk should contact their local health department for more information on getting vaccinated.

Is H1N1 testing a covered benefit?

Members who are admitted to the hospital are covered for H1N1 testing with coinsurance for lab services. H1N1 testing is not recommended on an outpatient basis because it could delay treatment, according to the latest Centers for Disease Control guidelines.

What about the use of antiviral drugs to treat pandemic H1N1?

Antiviral drugs, such as Tamiflu® and Relenza®, are prescription medicines that fight against the flu by stopping the reproduction of flu viruses in your body. If you get sick, taking antiviral drugs within 48 hours of first developing symptoms can lessen the severity of the illness. Antiviral drugs may also prevent serious flu complications. These medicines are not recommended for prevention of H1N1.

How much will Tamiflu® or Relenza® cost?

These are brand-name drugs and available at a brand-name copay. Members with group medical coverage but without pharmacy benefits may use their Providence Health Plan member ID cards to obtain prescriptions at Providence-contracted rates. The average Providence-contracted rate for a five-day course of Tamiflu® is $84 and for Relenza® is $55. When the state of Oregon releases the government stockpile, Tamiflu® and Relenza® will be available at designated locations for a $4 distribution fee. Visit www.flu.oregon.gov for updates.