Healthier Michiganders at Every Stage of Life
Vaccinations are key to creating and maintaining a healthy population, from birth through advanced age. The MHA supports efforts to educate communities about the importance of vaccinations in preventing serious illnesses in children, adults and healthcare personnel.
Beyfortus Vaccination
The MHA has heard significant concerns from members about the cost of purchasing and administering Beyfortus (nirsevimab), the monoclonal antibody for infants entering their first respiratory syncytial virus (RSV) season.
The MHA is diligently working with stakeholders to understand how members can be reimbursed for purchasing and administering this medication. Conversations with the Michigan Department of Health and Human Services (MDHHS) and Medicaid Health Plan on the subject yielded a recommendation that providers enroll in the Vaccines for Children (VFC) program. The VFC program covers the cost of purchasing ACIP recommended vaccines (which includes Beyfortus) while still allowing providers to charge an administration fee.
On Nov. 7, MDHHS released a letter detailing immunization coverage and how to obtain immunizations. In this letter, the Department discussed the VFC program and highlighted that it covers immunizations at no cost to children under 18 years and that for beneficiaries 19 years and older, Medicaid covers all required immunizations. The Michigan VFC Provider Manual has more details about the program including eligibility, enrollment procedures and vaccine ordering, storage and handling guidelines. MDHHS also has a two-page summary document which discusses the benefits of becoming a VFC provider and information on how to enroll. Birthing hospitals are eligible to participate in the VFC program as a ‘Specialty Provider’ and are only required to provide Hepatitis B and Beyfortus vaccines, allowing for additional flexibility and reduced barriers to enrollment.
The MHA continues to work with the Medicaid Health Plan and MDHHS to get more details, as well as with the commercial payers to understand the extent of vaccination coverage.
Private insurers are required to cover Beyfortus at no cost to patients but have 24 months following ACIP’s recommendation to comply; leaving eligible patients with questions about coverage for the 2023 season. Early reports from CMS & CDC indicate that most commercial payers are covering it already, which was confirmed by a statement from Sanofi that 90% of Beyfortus vaccines administered to privately insured patients in Sept. and Oct. 2023, were fully covered. (Nov. 8 webinar)
To note: CPT codes are now available for providers to use in billing these services.
Securing insurance coverage is a critical component of ensuring access, however the Centers for Disease Control and Prevention (CDC) has acknowledged and responded to the supply shortage of Beyfortus. CDC released prioritization criteria for clinicians, providing guidance on utilizing available vaccine doses for the most at risk patients.
Additionally, Sanofi, the Beyfortus manufacturer released a statement in October indicating that demand for the product has been higher than anticipated, and despite an aggressive supply plan, has not kept pace. This is in direct conflict to the commentary from MDHHS suggesting that the Beyfortus shortage is a “misconception by clinicians”. The MHA is working with MDHHS to understand whether there are doses available at the state level which can be provided to interested hospitals and health systems.
On Nov. 17, Sanofi indicated that 77,000 additional 100mg doses were manufactured and will be distributed primarily through the VFC program, though a limited allocation will be made to the private market. While Sanofi continues manufacturing Beyfortus and ships everything they make, all the Beyfortus product that they have committed to make in 2023 has already been allocated. In the event additional manufacturing capacity is added and additional doses become available, Sanofi will update providers.
Updated Nov. 28, 2023*
Adult and Childhood Immunizations
The MHA works with the Alliance for Immunizations in Michigan (AIM), the Parent Information Network (PIN), I Vaccinate and others to measure, educate and promote appropriate vaccinations for all Michigan residents. To learn more, contact us.
Healthcare Personnel
The MHA works with the Michigan Department of Health and Human Services (MDHHS) to strongly encourage hospitals and health systems to consider healthcare personnel vaccination policies that protect patients, staff and visitors from preventable illness. The MHA provides the following resources to assist members in vaccination efforts against preventable diseases, as recommended by the U.S. Centers for Disease Control and Prevention (CDC). The resources particularly focus on COVID-19, influenza and pertussis (whooping cough), each of which is highly contagious.
Policies that strongly encourage vaccination have proved to increase HCP coverage rates. The Care Compare website includes information on influenza vaccination rates for HCP under Timely and Effective Care, Preventive Care. In addition, the MDHHS urges healthcare providers to use the Michigan Care Improvement Registry (MCIR) to document all vaccine administration.
Hospitals can use the resources below to determine whether their policies adequately protect their HCP against COVID-19, influenza and pertussis. Contact the MHA for additional information on protecting everyone in the hospital from vaccine-preventable diseases.
Healthcare Personnel Vaccine Recommendations
- CDC Recommended Vaccines for Healthcare Workers, including COVID-19.
- Healthcare Personnel Vaccination Recommendations (one-page reference sheet from Immunization Action Coalition)
Resources and Additional Information on Reporting Requirements
- National Healthcare Safety Network (NHSN) Reporting of COVID-19 cases
- Form and Instructions for Weekly NHSN Reporting of HCP Vaccination for COVID-19
- NHSN CMS Requirements for Reporting HCP Vaccination for Influenza
- Form and Instructions for Seasonal Survey on Influenza Vaccination Program for HCP
In addition to reporting to the NHSN, providers are urged to report HCP vaccinations for COVID-19, influenza and pertussis to the Michigan Care Improvement Registry.