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INFLUENZA VACCINE MEDICARE COVERAGE

Executive Summary

INFLUENZA VACCINE MEDICARE COVERAGE will be evaluated under a demonstration project mandated by the Budget Reconciliation Act of 1987. The Act, which passed Congress Dec. 21, requires HHS "to conduct a demonstration project to test the cost-effectiveness of furnishing influenza vaccine under Medicare," beginning on Oct. 1, 1988 and running for two years. If HHS finds that coverage of influenza vaccine is cost-effective, "provisions providing coverage for influenza vaccine would become effective on Nov. 1, 1990," the Act states. The demonstration project would continue for an additional two years if HHS is unable to determine whether coverage is cost effective after the initial study period. If the two-year extension is necessary, HHS would be required to submit a final report no later than April 1, 1993. In that case, provisions for Medicare coverage would become effective on the first day of the month following submission of the report, unless HHS finds that coverage is not cost-effective. The Budget Reconciliation Act authorizes a spending level of $25 mil. per year under Medicare for the vaccine project for the elderly. "In lieu of direct reimbursement for the cost of vaccine, the Secretary [of HHS] shall arrange to provide the vaccine to be used in the demonstration project," the Act states. "The Secretary shall acquire the vaccine using the most cost-effective method, including purchase of the vaccine at bulk rates."
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