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  The Ultimate Guide to Flu-Shot Shopping
Reported by SmartMoney.com on Tuesday, 13 October 2009 (on October 13, 2009)
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Table: Flu Shot Prices
One thing about flu worries: They’re catching.
Already there is concern about the need for two shots this year — seasonal flu and H1N1, also known as swine flu. But with children in a handful of states already getting their nasal spray vaccines for H1N1, consumers are sorting through a bewildering maze of flu choices. Do I need both shots? What kind of immunization is best, shot or nasal spray? With retailers advertising they’ll do it for cheap, where do I go to get inoculated?
Weeks before the flu season’s official start of Oct. 4, the Centers for Disease Control and Prevention reported an elevated number of cases. From Sept. 20-26, the CDC reported 2,126 new cases of influenza nationwide -- all but 1% of them H1N1. News reports, letters home from school, and public safety campaigns, have both raised consumer awareness and triggered concerns about safety. Earlier this month, New York health-care workers protested mandatory H1N1 vaccinations, saying they shouldn’t be forced to receive a potentially dangerous vaccine to keep their jobs.
Another potential for concern: availability. Of the 2.4 million doses of H1N1 nasal spray vaccine shipped last week, health-care providers have already snapped up 2.2 million. The Connecticut attorney general is also seeking answers from manufacturer Novartis (NVS) regarding potential shortages of seasonal flu vaccine.
In fact, the confusion that consumers face this flu season underscores just how out of whack the U.S. health-care system can be, even as the nation debates reform. Doctors, for example, say flu vaccines do not contribute substantially to their income — and that they provide the doses as a public service. A 2008 University of Michigan survey found that nationwide, 11% of physicians said they were considering eliminating all immunization offerings for privately insured children because of the losses.
Dr. Anatoly Belilovsky, a pediatrician based in Staten Island, N.Y., says he pays Sanofi Aventis (SNY) about $140 for a 10-dose vial of Fluzone. He charges each patient being vaccinated the cost of a single dose ($14) and a $17 administration fee to cover office costs and his time (Belilovsky administers the shots himself), for a total of $31. Insurance reimburses him $20 to $30, including any copay. “You generally break even with private insurance,” he says.
Likewise, flu vaccines represent small profits for the large pharmaceutical companies that make them. GlaxoSmithKline's (GSK) Fluarix and FluLaval vaccines, for example, brought in roughly $135 million during 2008, or 0.91% of the company’s $14.7 billion U.S. pharmaceutical sales, according to the firm’s annual report. In comparison, its hepatitis vaccine took in $438 million, or 3% of U.S. sales.
However, both doctors and manufacturers could stand to profit. Down the road, manufacturers could cash in by expanding their sales to developing nations, says Hedwig Kresse, a senior analyst of infectious diseases for market researcher Datamonitor. China’s ongoing health-care reform, which aims to offer coverage to more than 90% of the population by 2011, is expected to be very lucrative for vaccine manufacturers, according to a July 2009 report from IMS Health. And in its 2008 annual report, Glaxo identified emerging market vaccine sales as one of its highest growth areas.
For doctors, there could be a benefit with patients who pay cash. According to the CDC, a 10-pack of FluMist Sprayers averages $19.70 per dose to physicians and retailers. Vaccines administered via injection average $9.72 to $13.25 apiece. Although doctors have to absorb the loss of providing the vaccine free to Medicare clients, they can also charge a premium to their uninsured patients.
The bottom line: Before you make any decision about your vaccines, be informed. Here are answers to some key questions about getting a flu shot. Be sure to click through to the end to see our chart on the prices and promotions big-name retailers are offering on seasonal flu immunizations.
How important is it that I get the seasonal flu vaccination?
Do your math. In an average year, 5% to 20% of consumers come down with seasonal influenza. If you get the vaccine, you reduce your risk of falling ill by 70% to 95%, says Dr. Litjen Tan, the director of medicine and public health for the American Medical Association. Most doctors recommend getting the shot if you’re in the high-risk group. For seasonal flu, that includes anyone 24 or younger, pregnant women and people with weakened immune systems, as well as those who have direct contact with an at-risk group.
Which at-risk groups might need the swine flu vaccine?
For H1N1, doctors advise the shot for people age 18 or younger, age 65 or older, pregnant women, people with weakened immune systems, and anyone who has direct contact with at-riskers.
Where should I get my seasonal flu shot?
The traditional route, of course, is through your physician. The upside here is privacy. The downside: You might end up paying a premium for the privilege. Doctors in private practice often bump up prices to cover the costs of providing free immunizations to Medicare participants, says Dr. Margaret Lewin, the chief medical director for insurer Cinergy Health and a clinical assistant professor at Cornell University’s Weill Medical College. The participants pay nothing out of pocket for immunizations (not even a copay), and doctors are reimbursed $13.22. That covers little more than the cost for the vaccine, says Lewin.
Of course, if you are insured, it’s unlikely you’ll pay anything beyond your physician’s usual copay, an average of $20. Aetna’s (AET) Cost of Care tool pegs the cost of immunization for someone in New York age 4 or older at an average $13 within their network and $39 out of their network; for ages 3 and younger, the costs are $11 and $48, respectively. In Portland, Ore., the costs are an average $16 and $20 for ages 4 and older; $9 and $27 for ages 3 and younger.
What about retailers that are offering the vaccine?
This year, retailers like Wal-Mart (WMT) and Walgreen (WAG) are splashing flu treatments all over their sale circulars. Why? They’re hoping you’ll stay to shop — and transfer in lucrative prescriptions, says Kit Yarrow, whose book “Gen Buy” assesses the motivations behind consumers’ purchases. Walgreen’s, for example, is charging $25 for a seasonal flu shot, a price-tag that has brought in 2.5 million customers since Sept. 1, says spokesman Jim Cohn. That is more than double the 1.2 million injections the retailer administered for last year’s entire eight-month flu season.
In case you’re worried about quality, you shouldn’t be. The injections are exactly the same as the ones that you would get from your doctor, and they are given by trained pharmacists or licensed practical nurses.
Can I just walk in and get a flu shot?
Not exactly. Some stores offer the vaccines as a daily service; others have set flu clinic days or require an appointment. Be sure to check availability and make sure all your family members are eligible. Wal-Mart and many other retailers will only accept patients age 9 and older, largely because the CDC recommends children younger than that see their primary care physician.
Where can I get a free seasonal flu shot?
Check with your human resources department. Seventy-one percent of employers offer free immunizations, according to benefits consulting firm Hewitt Associates. From a cost standpoint, employers would rather subsidize the cost of the shots than see a spike in health-care costs, says Bob Nelson, the president of Nelson Motivations, a benefits consulting firm. Currently unemployed? CVS is providing 100,000 vouchers for free vaccinations for the unemployed. (Pick up a voucher at a local One-Stop Career Center.)
Another option: Try your local hospital or health department. Both routinely offer programs, with high-risk groups getting first opportunity. To find a flu clinic near you, use the American Lung Association’s tool here and monitor your local news.
Does it matter if I get the mist or the vaccine?
The verdict is still out here. One recent study suggests that this season, the seasonal flu shot is more effective than FluMist, an inhalable nasal spray made by MedImmune. However, other studies suggest that vaccinations delivered via a nasal spray or via injection are equally effective, the AMA’s Tan says. Still others indicate FluMist may be more effective in young children. (The main caveat for FluMist, which contains live virus, is that it cannot be administered to pregnant women or other people with weakened immune systems, he says.) One argument for the shot: It’s cheaper. According to the CDC, a 10-pack of FluMist Sprayers averages $19.70 per dose to physicians and retailers. Vaccines administered via injection average $9.72 to $13.25 apiece. At Target (TGT), that translates into $24 for a shot and $36 for the nasal spray.
What if I don’t get the vaccine until October or November? Am I putting myself at risk?
The longer you wait, the more risk you take of contracting the flu, so keep that in mind while you’re shopping around. (The peak month for influenza activity has been February in 12 of the 26 flu seasons prior to last year’s, according to data compiled by the CDC. The runner-up for that period was January, in five years.) Even after you are vaccinated, it takes about two weeks for your body to develop enough antibodies to ward off the flu. After that, however, you are safe “until the end of the flu season [in May],” Tan says.
If I wait too long, will they run out of flu shot?
It depends what you mean by “run out.” Although most vaccine providers, particularly retailers, should have abundant supply, there could be gaps in availability. Makers are shipping the seasonal flu doses in waves, so it depends where you call. If you want your vaccine immediately, you could have to wait a few weeks. Sanofi Pasteur, the vaccines division of Sanofi Aventis, for example, recently announced it could take until November for doctors and retailers to receive the rest of their orders. That is because the company took a break to manufacture the H1N1 vaccine.
When will the H1N1 vaccine be ready? Will there be enough to go around?
The first doses of the H1N1 vaccine rolled out to health-care providers nationwide last week. But the CDC is cautioning that it may take until November for enough of the vaccine to be in the market for widespread immunization. Cities and states say early doses will go to at-risk groups. New York City, for example, says its first shipment will be split between health-care workers and doctors treating children. The government promises that anyone who wants an H1N1 vaccine will receive one.
If the government is paying for H1N1, does that mean it will be free everywhere?
The vaccine will be free, though you may be hit with an insurance copay to receive it at the doctor’s office. (Many insurers are dropping the fee.) States are also planning clinics at hospitals, schools, retailers and other locations.
If I think I had H1N1 last year, but never had it confirmed with a test, how will getting the vaccine affect me?
There shouldn’t be any adverse effects, according to the CDC.
Here’s a sampling of the prices and promotions big-name retailers are offering on seasonal flu immunizations:
Flu Shot Prices
RetailerCostPromotions
* Price applies for warehouse club members as well as walk-in non-members.
A&P, Pathmark, Waldbaum’s$30Customers receive a buy-one, get-one-free certificate for flu shots when they purchase $100 in health and beauty care products before the end of October. They also receive a free booklet with $50 worth of coupons, while supplies last.
BJ’s $30*N/A
Costco $20*N/A
CVS $30Customers receive a free booklet containing $100 in-store coupons, while supplies last.
Giant Food, Stop & Shop$30Members of the supermarket chain’s free loyalty program get a $10 discount, lowering the price to $20.
Jewel-Osco$25Customers who receive a flu shot and purchase other pharmacy services (such as health screenings and other immunizations) receive a coupon for 20% off their next grocery purchase. They also get a free cold survival kit with coupons and samples, a $30 value.
Rite Aid $30N/A
Safeway $30Customers receive a coupon for 10% off their next grocery purchase.
Sam’s Club$20*N/A
Target $24N/A
Walgreen$25Uninsured adults can visit the drugstore chain’s traveling Wellness Tour Bus to receive a voucher for free flu immunization.
Wal-Mart$28N/A
Winn-Dixie $24Members of the supermarket chain’s free loyalty program get a $5 discount, bringing the price to $19.
SMARTMONEY ® Layout and look and feel of SmartMoney.com are trademarks of SmartMoney, a joint venture between Dow Jones & Company, Inc. and Hearst SM Partnership. © 1995 - 2009 SmartMoney. All Rights Reserved.
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