Flu Shot Information for TRICARE Beneficiaries

According to the Centers for Disease Control and Prevention (CDC), the flu affects 5-20 percent of the U.S. population each year. Symptoms can include fever, muscle aches, nausea and vomiting, and complications can include bacterial pneumonia and ear and sinus infections.
With flu season just around the corner, now is the time to vaccinate your patients. TRICARE covers influenza vaccinations for TRICARE beneficiaries based on the CDC’s current flu season guidelines. According to the CDC, all persons, including school-aged children, who want to reduce the risk of becoming ill with the flu or transmitting it to others, should be vaccinated.
As the flu season begins, here are some important points regarding flu shots for TRICARE beneficiaries in the West Region.

Who Should Be Vaccinated?

• All children beginning at six months through 18 years
• Adults age 50 and older
• Nursing home residents and other individuals in long-term care facilities housing anyone of any age with chronic medical conditions
• Adults and children with chronic disorders of the lungs or heart such as asthma, COPD (Chronic Obstructive Pulmonary Disease), Emphysema, Chronic Bronchitis, or Cystic Fibrosis
• People who have a suppressed immune system
• Children and teens on long-term aspirin therapy
• Healthcare providers

Who Should Not Be Vaccinated?

The flu vaccine has been grown on egg protein; therefore the flu vaccine is not recommended for people who have a history of severe chicken egg allergy. If the patient has been able to eat eggs, he/she may be able to receive the flu vaccine.
Others who should not be vaccinated include:

• People who have had a severe reaction to an influenza vaccine in the past.
• People who developed Guillain-Barre syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
• Children less than 6 months of age (influenza vaccine is not approved for use in this age group).
• People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

When to Vaccinate?

Each year, the flu vaccine is developed with three strains of influenza virus. These strains have been identified as the cause for the illness in the upcoming year. The best time to vaccinate patients is October through November, but vaccinating in December or even later can still be beneficial because most influenza activity occurs in January or later in most years. Though it varies, flu season can last as late as May.

TRICARE Coverage

Below is a chart comparing influenza vaccination coverage for TRICARE Prime, Standard, Extra and Prime Remote beneficiaries.

TRICARE Program	Influenza vaccination coverage	Vaccine location	Deductibles or cost-shares
Prime	Yes	Primary care manager (PCM) (Network or MTF)	None, unless using a non-network provider without a referral
TRICARE Prime Remote	Yes	Network or non-network provider	None
Standard/Extra	Yes	Network or non-network provider	None

Here are some additional important points regarding influenza vaccination coverage:

• If a TRICARE Prime beneficiary goes to a retail outlet, such as a drug store or a grocery store for his or her vaccine and the vaccine is provided by a non-network TRICARE-authorized provider such as a nurse, the shot will be paid under the point-of-service (POS) benefit. County health services employees are not TRICARE-authorized providers and therefore, the claim will not be paid.
• TRICARE currently does not recognize the administration of vaccines by pharmacists.
• Except for beneficiaries over 50 years old, flu mist is a TRICARE covered benefit when administered by a network provider or by a TRICARE Prime beneficiary’s PCM.
• Beneficiaries should check with their PCM and local MTF for availability (hours, locations)

What about the Pneumococcal Vaccine?

The Pneumococcal vaccine can lessen the chance of Pneumococcal pneumonia. Although Pneumococcal pneumonia may occur as a major complication of the flu, the vaccine is not a substitute for the flu vaccine. The Pneumococcal vaccine helps to protect someone from strains of bacterial pneumonia. It is generally recommended for many of the same high-risk people for whom influenza vaccine is recommended. People with emphysema, COPD, congestive heart failure, cirrhosis, renal failure, diabetes or Hodgkin’s disease should be given the Pneumococcal l vaccine. In addition, people over age 65, and those with asymptomatic HIV infection should receive the vaccine. The Pneumococcal vaccine is given every 5-7 years. It is safe to receive both the influenza and Pneumococcal vaccines at the same time.

For more information on flu season guidelines, visit the CDC Web site at www.cdc.gov/flu, www.tricare.mil, www.triwest.com/provider or contact TriWest at 1-888-TRIWEST (888-874-9378).

Published Date: 10/14/2009