Sample Letter for Proactive Request for Coverage of CPT 90715

Sample Letter for Proactive Request for Coverage of CPT90654 in Retail Setting

(Instructions: Remove the heading and this instruction statement and print on your letterhead.)

[Date]

[Payer Name]

[Payer Address]

[PayerCity, State, ZIP code]

[Salutation]:

Please regard this letter as a formal request to addNDC 49281-705-55 (CPT®a 90654) as a payable code forFluzone®Intradermal,Influenza Virus Vaccinein your agreement with[insert name]. As a reference, average wholesale price (AWP) for Fluzone Intradermal vaccine is $19.351 per dose. The Medicare payment for the vaccine is $18.38.2The national average Medicare payment for administration of the vaccine (G0008 valued equal to CPT 90471) is $24.17.3

As of the 2010-2011 influenza season, the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices expanded its influenza vaccine recommendations to include all persons 6 months of age and older.4 Even with this broad recommendation, adult immunization rates against influenza disease remain low.5Providing access to vaccines in pharmacies is a proven strategy towards increasing immunization rates.6In the 2010-2011 influenza season, the CDC estimated that pharmacists administered almost 20% of the influenza vaccines provided to adults in the United States.6

In addition to increasing access points, advertising and media attention around influenza vaccination is a key component of raising immunization rates. Prior to the 2012-2013 influenza season, Sanofi Pasteur, the supplier of Fluzone Intradermal vaccine, will be conducting a broadnational consumer awareness campaign focusing on the need for immunization against influenza disease. Fluzone Intradermal vaccine,the first influenza vaccine delivered by microneedle injection, will be featured in this consumer campaign. In over a year of research conducted by Sanofi Pasteur with adult consumers, it was found that not only would many adults who already get vaccinated each year be receptive to receiving a vaccine with a 90% smaller needle, but millions of adults who do not get vaccinated as routinely would be more likely to seek vaccination if Fluzone Intradermal vaccine were made available to them.

Based on the media attention, we expect that your members will be coming to our locations requesting Fluzone Intradermal vaccine. Availability of the vaccine may contribute to both the member’s willingness to be immunized and his or her satisfaction with the services provided by the health plan and our pharmacies.

I ask that you include Fluzone Intradermal vaccine (CPT 90654) and its administration as payable services in our agreement so that legitimate claims are not denied.I appreciate the time you take to review this request. Please contact me at [telephone number] if you have any questions.

Sincerely,

[Provider’s name]

aCPT=Current Procedural Terminology is a registered trademark of the American Medical Association.

References: 1.Medi-Span. Price Rx. Indianapolis, IN. May 2011. 2.Centers for Medicare and Medicaid Services (CMS). Seasonal Influenza Vaccines Pricing. Accessed March 228, 2012. 3.CMS. Medicare Physician Fee Schedule. Accessed March 28, 2012. 3.Centers for Disease Control and Prevention (CDC). Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR. 2010;59(RR-8):1-68.4. CDC. Interim results: state specific influenza vaccination coverage---United States, August 2010-February 2011. MMWR.2011; 60(22);737-743.5. American Pharmacist Association and Academy of Managed Care Pharmacy. Pharmacist-provided immunization compensation and recognition: White paper summarizing APhA/AMCP stakeholder meeting. J Am Pharm Assoc. 2011; 51: 704-712.