Widespread confusion over flu shot insurance benefits

Three pharmacists who asked not to be identified for fear of retaliation by their employers said drugstores obtain flu shots from wholesalers for roughly $8 apiece.

Reimbursement by insurers can vary among pharmacy chains. At one prominent chain, I was told, reimbursement runs close to $14 a shot. At another chain, reimbursement is typically "a few dollars less than the retail price of the shot," according to a senior executive.

In either case, it seems clear that charging customers the full retail price represents more profit for the drugstore than if an insurer is involved — nearly 300% over the wholesale price for shots costing about $30.

Up to 145 million flu-shot doses are expected to be produced this season, according to the Centers for Disease Control and Prevention.

Representatives of CVS, Walgreens, Rite Aid and Target declined to say how much each chain pays for flu shots or how much each is reimbursed by insurers.

But Ashley Flower, a Rite Aid spokeswoman, said company workers routinely check to see whether a flu shot is covered either as pharmacy or medical benefits. If it's not covered, "the cash price for the standard injectable flu shot is $29.99," she said.

Jamie Bastian, a Target spokeswoman, said that "many factors can impact pharmacy charges, including a guest's insurance plan, if a provider has named the pharmacy a preferred location and the guest's deductible."

If nothing else, these mixed signals on flu shot coverage highlight a need for greater coordination among healthcare companies.

Preventive medicine is in everyone's interest. Consumers hopefully will avoid catching the flu or will have only mild symptoms as a result of receiving a vaccination.

Insurers lower their risk of a policyholder being hospitalized or catching pneumonia. And drugstores, of course, enjoy a brisk business providing millions of shots.

It seems insane that a treatment this important and commonplace is the source of so much confusion. And that's giving pharmacies the benefit of the doubt in claiming they're not trying to cheat people out of insurance.

Is that trust warranted?

Considering the high number of consumers saying they've been misled by drugstores, this seems like a question for state Atty. Gen. Kamala D. Harris to answer. A spokesman for her office declined to comment.

In the meantime, consumers have to serve as their own flu-shot watchdogs.

Ellen Klein, 56, recently visited a CVS store in Westchester for her vaccination. She was told by a pharmacy worker that her insurance didn't cover the shot and thus paid about $30 out of pocket.

"I was surprised," Klein said. "They have my insurance information on file. I go to that CVS all the time."

After seeing my earlier column, she called her insurer, Aetna, and asked about her coverage. The Aetna rep said she was covered for flu shots at CVS and most other major pharmacies.

The rep proceeded to ask Klein to fax in her CVS receipt. Aetna would reimburse her for her expense, the rep said.

"He even apologized for what happened," Klein recalled.

And in case you were wondering, that's a health insurer behaving in a stand-up fashion.

David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send your tips or feedback to david.lazarus@latimes.com.

Featured Stories

CTnow is using Facebook comments on stories. To comment on ctnow.com articles, sign into Facebook and enter your comment in the field below. Comments will appear in your Facebook News Feed unless you choose otherwise. To report spam or abuse, click the X next to the comment. For guidelines on commenting, click here.

CONSUMER COLUMNISTS

Kevin Hunt - The Electronic Jungle

Kevin Hunt: Wanna-Haves For The Tailgater - August 8, 2014 - Back-to-school season usually doesn't deserve a celebration, except by some parents, but it coincides with two other seasons —...

Gail MarksJarvis

Investors await Yellen's words from Wyoming, where Fed meets this week - August 19, 2014 - This week, the Federal Reserve will go into one of the most carefully scrutinized events of the year when it debates whether employment...

David Lazarus

A good alternative to having a colonoscopy? Maybe not - August 21, 2014 - There are few medical tests with as high a squirm factor as colonoscopies.

Korky Vann

Books Inspiring Global Tours, Journeys - August 3, 2014 - Book lovers who head out to visit authors' homes, museums and gravesites are part of a new chapter in travel called "literary tourism."

Advertisement

...