According to the Centers for Disease Control and Prevention (CDC), more than 220,000 people in the United States are hospitalized each year due to flu-related causes. TRICARE® covers age-appropriate doses of annual influenza vaccines based on the current CDC influenza season guidelines for all beneficiaries.
With flu season just around the corner, now is the time to vaccinate your patients. TRICARE coverage includes both the flu shot and the nasal spray vaccine (FluMist®).
The 2012-2013 flu vaccine will protect against three different flu viruses:
- A/California/7/2009 (H1N1) pdm09-like virus
- A/Victoria/361/2011 (H3N2)-like virus
- B/Wisconsin/1/2010-like virus (from the B/Yamagata lineage of viruses)
Healthy patients of any age may receive the flu shot. The nasal-spray vaccine should only be administered to healthy people ages 2 through 49, except for pregnant women.
Enrollees in TRICARE Prime or TRICARE Prime Remote (TPR) can receive the seasonal flu shot at no cost from TRICARE network providers or participating TRICARE retail network pharmacies. Uniformed Service members (Active duty, National Guard, and Reserves) are required to get flu vaccine. ADSMs have priority for getting the vaccine at military treatment facilities, but may also get the vaccine at a participating TRICARE retail network pharmacy at no cost. Note: TRICARE Prime and TPR enrollees who obtain the flu vaccine from non-network providers without referrals and authorizations may incur point-of-service charges.
TRICARE Standard and TRICARE Extra beneficiaries can get the flu vaccine from TRICARE-authorized providers or TRICARE retail network pharmacies. Deductibles and cost shares are waived.
The Express Scripts, Inc. website at www.express-scripts.com/TRICARE lists participating pharmacies.
High-Risk Categories
TRICARE encourages you to recommend the flu vaccine to all of your patients, particularly those who fall into one of the following high-risk groups, as identified by the CDC:
- Children ages 6 months to 18 years
- Pregnant women
- People ages 50 and older
- People with certain chronic medical conditions
- People who live in nursing homes or other long-term care facilities
- People who live with, care for or otherwise interact with patients in the above categories should also receive annual flu vaccines. These people may include health care workers, caregivers and others.
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 have any severe (life-threatening) allergies.
- 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.
For more information about TRICARE’s flu vaccine coverage, visit www.tricare.mil/flu.