You asked for information on the role played by the Massachusetts Department of Public Health in the acquisition and distribution of flu and pneumonia vaccine and how this compares to Connecticut. (A previous OLR report (2001-R-0686) addresses Connecticut's flu vaccine distribution for the 2001-2002 season and is attached. )

SUMMARY

Massachusetts' public health department is actively involved in the acquisition and distribution of flu and pneumonia vaccines. It uses state funds annually to purchase and distribute them based on those at highest risk. Massachusetts also allows pharmacies to distribute flu vaccines at selected sites under a pilot program.

In contrast, Connecticut's public health department undertakes a guidance and advisory role in the acquisition and distribution of these vaccines. Most vaccines are distributed privately through various providers and organizations. Local health departments also acquire and distribute the vaccines.

MASSACHUSETTS

The immunization program of the Massachusetts Department of Public Health (MDPH) is actively involved in the acquisition of influenza and pneumonia (pneumococcal) vaccine. MDPH purchases influenza vaccine on an annual basis and distributes it to those at highest risk of influenza and its associated complications. State-supplied vaccine is primarily distributed to municipalities for use at public flu clinics where the vaccine is offered to high-risk individuals who may not otherwise have access to vaccines. A recent MDPH advisory (February 2002) also states that state-supplied vaccine is "also prioritized to long term care facilities for their at-risk populations and for high-risk children seen in private physician offices as part of the MDPH's universal childhood immunization program. "

Massachusetts has also initiated a pilot program in which pharmacists can offer and distribute flu vaccine to consumers on-site. The state has selected about 20 pharmacies to participate in this program with the goal of increasing flu immunization rates. (Connecticut does not have such a program. )

MDPH anticipates being able to purchase at least the same amount of influenza vaccine for the 2002-2003 flu season that was distributed this past season. But it cautions, "as in previous years, state-supplied vaccine will not be sufficient to meet the demand for flu vaccine in Massachusetts. Health care providers should therefore begin planning now for the next flu season by privately purchasing influenza vaccine" (MDPH Advisory, February 2002). MDPH recommends consideration of the following strategies:

1. Prioritize Vaccine: Ensure that only people at high risk for complications from influenza receive the limited state-supplied vaccine. These people include everyone 65 years of age and older, younger people with certain medical conditions, and all residents of long-term care facilities.

2. Collaborate and Coordinate: Establish collaboration and coordination among all flu vaccine providers in your community to ensure that all high-risk residents will have access to flu vaccine. Flu vaccine providers include the local health department, private health care providers, hospitals, long-term care facilities, visiting nurses associations (VNAs), and local pharmacies and supermarkets.

3. Seek Medicare Reimbursement: All public and private providers should plan to take advantage of Medicare Part B reimbursement for the purchase and administration of influenza and pneumococcal vaccine. Providers can get reimbursed for the purchase and administration of privately-purchased vaccine and for the administration of state-supplied vaccine.

4. Seek Health Plan Reimbursement: Local health departments and VNAs should plan to take advantage of Medicare Health Plan Reimbursement for administration of influenza and pneumococcal vaccine to managed care plan members at public clinics.

5. Submit Orders Early: Plan to submit orders for privately-purchased flu vaccine. The earlier your order is submitted, the better the price you are likely to get.

6. Use Pneumococcal Vaccine: Ensure that all adults at risk for pneumococcal disease have received pneumococcal polysaccharide vaccine (PPV23). PPV23 is available from the MDPH at no cost for all at risk Massachusetts residents.

CONNECTICUT

No state funds are appropriated to Connecticut's Department of Public Health (DPH) to purchase and distribute flu and pneumonia vaccines. Current state immunization funding is just for childhood immunizations. DPH's role tends to be more advisory in nature, to ensure that the federal Centers for Disease Control and Prevention (CDC) recommendations are implemented (see the attached CDC Bulletin #2 for the 2002-2003 flu season for example). It also conducts surveillance of flu and pneumococcal disease and morbidity in Connecticut residents.

Historically, 90% of the flu and pneumococcal vaccinations for adults in the state are given through the private sector. Public sector provision of these vaccines to adults through local health departments roughly represents the other 10%. Local health departments use their own funds to sponsor annual flu/pneumococcal clinics for their residents. (Medicare pays for immunizations for those 65 years and older. )

Legislation adopted this session (PA 02-10) requires the DPH commissioner to adopt regulations for the prevention of influenza and pneumococcal disease in nursing homes. The regulations must assure that each nursing home patient is immunized annually against influenza and pneumonia according to recommendations of the National Advisory Committee on Immunization.

JK: ts