1. Medicare B & D: Vaccines Sapna N. Patel UCSF School of Pharmacy Pharm. D. Candidate 2008 Pro Pharma February 22, 2008

2. Defining Immunization Immunization may be active or passive:  Active immunization: stimulation with an antigen to develop immunologic defenses against future exposure  Passive immunization: administration of preformed antibodies to someone who is already exposed or is about to be exposed to an antigen

3. Importance of Immunization Important component of preventative health care Cost-effective in preventing disease Increasing accessibility Non-invasive Quick, easy to administer

4. Hepatitis B Host: Humans Transmission: Blood, Serous Fluids Risk Factors: Multiple Sexual Partners, MSM, IVDU Symptoms: Nonspecific prodrome of malaise, fever, headache, myalgia, BUT at least 50% people are asymptomatic Complications: Fulminant hepatitis, hospitalization, cirrhosis, hepatocellular carcinoma, death

5. Pneumonia Host: Humans Transmission: Respiratory, Self-Infection Risk Factors: Adults> 65 years, chronic illness, asplenia, immunocompromised (disease, chemotherapy, steroids), high risk environments Symptoms: Acute fever, chills, chest pain, productive cough, dyspnea, hypoxia Complications: Bacteremia, meningitis, death

6. Influenza Host: Humans and Animals Transmission: Respiratory, airborne Risk Factors: HIV, pregnancy, healthcare providers, chronic illnesses (ex: CV, diabetes, renal dysfunction, immunosuppression) Symptoms: Acute fever, myalgia, sore throat, nonproductive cough, headache Complications: Pneumonia, myocarditis, death

7. Medicare Part D Coverage:  Influenza  Pneumococcal  Hepatitis B  Acute care situations

8. Medicare B Coverage:  All other vaccines not covered under Part D Details:  Intermediate to high risk patients in retail, home infusion and long-term care settings

9. Part D vs. Part B Part DPart B Covers major vaccines Broader coverage Can cover for acute exposure in emergency settings Specific formulary difficult to obtain Zoster, Meningococcal, Tetanus vaccine > 60 years not covered Will not cover acute exposure

10. Why is this important? Hepatitis B: more than 350 million chronically infected worldwide, well-established cause of chronic hepatitis and cirrhosis Pneumonia: highly Infectious, estimated 175,000 hospitalizations per year in the United States, meningitis complications: fatality rate ~30% Influenza: affects people of all ages and is estimated to cause 36,000 deaths/year

11. Summary Vaccines are important component of preventative health care Medicare Part D offers coverage of major vaccines for influenza, pneumococcal, hepatitis B, acute care setting vaccines Medicare Part B has a wider scope of coverage including non-Part D covered vaccines

12. References 1. http://www.cdc.gov/vaccines/pubs/pinkbook/default.htmlhttp://www.cdc.gov/vaccines/pubs/pinkbook/default.html 2. Keusch T, Bart K, Miller M, Harrison’s Principles of Internal Medicine. 16 th edition, 2005. 3. Pharmacist-provided immunization and Managed Care, AMCP Draft assessed 2/19/2008. 4. [online] available www.cms.hhs.gov/PrescriptionDrugCovContra/Downloa ds/PDBMChap6FormularyReqrmts_03.09.07.pdf, 2/19/2008. www.cms.hhs.gov/PrescriptionDrugCovContra/Downloa ds/PDBMChap6FormularyReqrmts_03.09.07.pdf 5. [online] available www.cms.hhs.gov/prescriptiondrugcovgenin/downloads/ partbandpartddoc_07.27.05.pdf, 2/19/2008. www.cms.hhs.gov/prescriptiondrugcovgenin/downloads/ partbandpartddoc_07.27.05.pdf