Amendment to influenza vaccine funding criteria

Medicines

Decision

PHARMAC is pleased to announce that the funding criteria for influenza vaccine have been amended with respect to children under the age of 5 years with significant respiratory illness.

In summary, the effect of the decision is that, from 1 April 2013, children with a history of significant respiratory illness will be eligible for funded influenza vaccination.

Details of the decision

The funding criteria applying to influenza vaccine will be amended from 1 April 2013 as follows (additions in bold):

A) is available each year for patients who meet the following criteria, as set by PHARMAC:

a) all people 65 years of age and over;
b) people under 65 years of age with:

i) the following cardiovascular disease:

1) ischaemic heart disease,
2) congestive heart disease,
3) rheumatic heart disease,
4) congenital heart disease, or
5) cerebo-vascular disease;

ii) the following chronic respiratory disease:

1) asthma, if on a regular preventative therapy, or
2) other chronic respiratory disease with impaired lung function;

iii) children aged four and under who have been hospitalised for respiratory illness or have a history of significant respiratory illness.
iv) diabetes;
v) chronic renal disease;
vi) any cancer, excluding basal and squamous skin cancers if not invasive;
vii) the following other conditions:

a) autoimmune disease,
b) immune suppression,
c) HIV,
d) transplant recipients,
e) neuromuscular and CNS diseases,
f) haemoglobinopathies, or
g) children on long term aspirin.
h) pregnancy.

c) people under 18 years of age living within the boundaries of the Canterbury District Health Board

The following conditions are excluded from funding:

a) asthma not requiring regular preventative therapy,
b) hypertension and/or dyslipidaemia without evidence of end-organ disease.

B) Doctors are the only Contractors entitled to claim payment from the Funder for the supply of influenza vaccine to patients eligible under the above criteria for subsidised immunisation and they may only do so in respect of the influenza vaccine listed in the Pharmaceutical Schedule.

C) Individual DHBs may fund patients over and above the above criteria. The claiming process for these additional patients should be determined between the DHB and Contractor.

D) Stock of the seasonal influenza vaccine is typically available from February until late July with suppliers being required to ensure supply until at least 30 June. Exact start and end dates for each season will be notified each year.

Background

In February 2013 the Immunisation Subcommittee of PTAC reviewed funded access to influenza vaccine following the release of the Southern Hemisphere Influenza Vaccine Effectiveness Research and Surveillance (SHIVERS) project 2012 findings. The SHIVERS study reported that children aged 4 years and under were most affected by influenza virus with the highest rate of influenza hospitalisation.

The Immunisation Subcommittee recommended that PHARMAC clarify access for children aged 4 and under who have a history of significant respiratory illness, to ensure they received funded influenza vaccinations. Children receiving a first course of influenza vaccine are required to have two doses of vaccine one month apart.

This decision has been taken to enable implementation for the current influenza season, which began on 12 March 2013. The information for the 2013 influenza vaccination season has already been produced and the change will not be reflected in this information.

PHARMAC requests that, in order to ensure supply is maintained for children under the age of 9 years, clinicians ring-fence stock of the GlaxoSmithKline influenza vaccine, Fluarix, for this age group.

More information

If you have any questions about this decision, you can call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 66 00 50.