2016-2017 Seasonal Flu Facts for Practitioners

As the primary source of medical information for our members, we encourage you to counsel patients on the importance of getting the flu vaccine and to allay any fears or concerns they might have about the vaccine. Also, discuss the pneumonia vaccination with patients as appropriate.

To help you get the information you need this flu season, listed below are several sources that you may reference:

CDC Recommendations for the 2016-2017 Flu Season

According to the Centers for Disease Control and Prevention (CDC), all people six months of age and older without contraindications should be vaccinated for the flu1. The CDC recommends that LAIV4 (quadrivalent live attenuated influenza vaccine) nasal spray not be used during the 2016–17 season for any population.

Health care providers should offer a flu vaccination to all patients by the end of October, if possible. Children aged 6 months through 8 years who require 2 doses should receive their first dose as soon as possible after vaccine becomes available, and the second dose ≥4 weeks later. Vaccination should continue to be offered as long as influenza viruses are circulating and unexpired vaccine is available. To avoid missed opportunities for vaccination, providers should offer vaccination during routine health care visits and hospitalizations when vaccine is available.

CDC recommendations for influenza vaccination of persons with egg allergy have been modified. The recommendations for the 2016–2017 flu season are:

  1. Persons with a history of egg allergy who have experienced only hives after exposure to egg should receive influenza vaccine. Any licensed and recommended influenza vaccine (i.e., any age-appropriate IIV or RIV3) that is otherwise appropriate for the recipient’s age and health status may be used.
  2. Persons who report having had reactions to egg involving symptoms other than hives, such as angioedema, respiratory distress, lightheadedness or recurrent emesis; or who required epinephrine or another emergency medical intervention, may similarly receive any licensed and recommended influenza vaccine (i.e., any age appropriate IIV or RIV3) that is otherwise appropriate for the recipient’s age and health status. The selected vaccine should be administered in an inpatient or outpatient medical setting (including but not necessarily limited to hospitals, clinics, health departments and physician offices). Vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic conditions.
  3. A previous severe allergic reaction to influenza vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine.

The CDC also notes that the vaccination is especially important for people at higher risk of severe influenza and their close contacts, including health care personnel and close contacts of children younger than six months. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to the following persons who are at increased risk for severe complications from influenza:

  • Children ages 6 months through 59 months
  • Pregnant women and women who will be pregnant during flu season
  • People 50 years of age or older
  • People with chronic pulmonary disease (including asthma), cardiovascular disease (except isolated hypertension) and renal, hepatic, neurologic, hematologic or metabolic disorders (including diabetes mellitus)
  • Persons who have immunosuppression (including immunosuppression caused by medications or by HIV infection)
  • Children and adolescents (aged 6 months to 18 years) who are receiving long-term aspirin therapy
  • Residents of nursing homes and other long-term care facilities
  • American Indians/Alaska Natives
  • People who are extremely obese (BMI ≥40).

Coverage for Flu Vaccines and Medications

When one of our members visits your office only to get a flu vaccine, there is no copayment, deductible or coinsurance. If the visit is for any other reason and the member also receives a flu vaccine, the regular copayment, deductible and coinsurance applies.

Our members with a combined medical and pharmacy benefit are also covered for influenza antiviral medications as provided for in the Certificate of Coverage or contract.

Approved Locations for Free Flu Vaccinations

We’ve encouraged our members to call their doctor to get the flu vaccine. If your office has the capability this season, please view any visit as an opportunity to vaccinate against the flu. If you are not providing vaccines, please tell your patients they can get a flu vaccine at a network pharmacy, provided that their benefit allows coverage.

EmblemHealth contracts with Express Scripts to provide flu vaccines at network pharmacies.

NOTE: Medicaid and Child Health Plus members under the age of 19 must see their doctor to get a free vaccine and are not covered for a free vaccine at any other location.

Obtaining and Reporting Vaccines for Children Under 19 Years of Age

As in years past, the seasonal flu vaccine can be obtained through established office practices. Children under the age of 19 who are uninsured, underinsured, Native American or are enrolled in Medicaid Managed Care or Child Health Plus are covered by the Vaccines for Children (VFC) program and office practices will not be reimbursed by the plan. Physicians who care for these populations may obtain vaccines through the VFC program.

There are reporting requirements for health care professionals administering vaccines to children under the age of 19. Requirements differ depending on where you are located:

Within New York City, vaccines administered to children under the age of 19 must be reported to the New York City Department of Health and Mental Hygiene’s Citywide Immunization Registry (CIR), as per New York City Health Code §11.07. Call 1-212-676-2323 or visit the CIR website for more information about the registry and how to report.

Outside of New York City, vaccinations must be reported to the New York State Immunization Information System.

Want more information? Visit the CDC’s website for information on this season’s flu vaccine. Your county or the New York State Department of Health can also help you learn more.


1 http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html