AH087 - 2025 Flu Season Update, with Libbi Green, PharmD

Table of contentS

Listen on:

Listen on

Spotify

Listen on

Apple Podcast

Listen on

Amazon Music

Listen on

Audible

Listen on

iHeart Radio

No items found.

In this episode of the Astonishing Healthcare podcast, return guest Libbi Green, PharmD (Manager, Formulary Operations) joins Justin Venneri for a discussion about the 2025 flu season, including the latest vaccine-related updates that employer plan sponsors and plan members need to know. We discuss the effectiveness of last year's flu vaccines, factors influencing the rates, vaccination timing, and how there can be differences in state vs. federal guidelines, among other topics!

Highlights

Larger employers may need to tailor flu programs across different states due to varying regulations.
Federal agencies - ACIP and the CDC - are recommending the annual flu vaccine but are emphasizing single dose formulations that are free of preservatives.
For people who regularly get or would like to get the flu vaccine, the timing is good now, before the end of October. For other vaccines - COVID, etc. - it's important to discuss timing and need with providers to reach a "shared decision."
For plan sponsors, working with a PBM partner "to ensure patients have the access that they need and that you're meeting all regulatory compliance" is crucial.
Judi®'s flexibility helps allow plan sponsors to react quickly and ensure vaccine-related claims are appropriately processed for their populations.

Listen in below or on Apple, Spotify, or YouTube Music!

Transcript

Lightly edited for clarity.‍

[00:22] Justin Venneri: Hello and thank you for listening to another episode of the Astonishing Healthcare Podcast. This is Justin Venneri, your host and Senior Director of Communications at Judi Health. And Libbi Green is back in the studio with me today.

She was our guest for episode 38 about a year ago when we last talked about flu season. So aside from our rebrand to Judi Health, a care navigation acquisition, a new sports partnership, unified claims - it's been a heck of a year, and I think you've got a new addition to the family. Is that right, Libbi?

[00:49] Libbi Green, PharmD: That's right. I have an 11-month-old son at home. He's getting into everything, popping anything he can grab hold of into his mouth. So, illness prevention is at the forefront of our minds for our family. You know, perfect timing for this episode, right?

[01:08] Justin Venneri: It's funny because I think we barely got the last one recorded before you went out on maternity leave. It is funny how quickly time flies.

So this time around though, it's interesting because there is a lot of controversy around vaccines and I just started getting my email reminders from my local pharmacy and Walgreens. So, we're going to do our best to just avoid the controversy about vaccines and just share information that should be helpful or interesting to plan members or plan sponsors.

So Libbi, thanks for coming back on. You're a pharmacist on our team. Tell us a bit about your role here for anyone that didn't listen to last year’s episode.

[01:39] Libbi Green, PharmD: Thanks again for having me back on. I am a pharmacist here at Judi Health with our formulary operations team. So I work with our health plan clients, helping them create custom formulary offerings across multiple lines of business - Commercial, Medicaid and Exchange - helping them tailor their formulary offerings and operationalize those benefits for them.

[02:07] Justin Venneri: Okay, flu season, the timing, give us a little refresher. And why is now a good time to be talking about this?

[02:13] Libbi Green, PharmD: Flu season is upon us already. Flu season runs from the fall into the spring months. Most activities start in October and then really peak in the winter between December and February. So being at the beginning of the flu season now, it's really the perfect time to get your yearly flu shot.

The goal is to get vaccinated by the end of October. That gives your body at least two weeks to build up an immune response to the vaccine before the flu activity really ramps up for the season.

[02:52] Justin Venneri: And last year I think we talked a little bit about forecasting activity, and there's a little bit of a curveball question for you, doing this episode on short notice. The flu usually comes from the Southern hemisphere up to us, right? Is there any estimate of how, quote, unquote, bad this year could be relative to last year? Have you seen anything on that yet?

[03:08] Libbi Green, PharmD: Yeah, we look to our neighbors in the Southern hemisphere. So, you know, Australia, those folks will get their flu season ahead of us. So we always get kind of a sneak preview as to what our flu season could look like. Forecasting based on their numbers so far, you know, it looks to be a pretty standard season.

Nothing too crazy with the circulating strains out there. The CDC here in the US does monitor those circulating viruses to make sure that the components in the yearly vaccine are being selected to try to match what we predict will be highest circulating throughout the flu season. So, you know, we definitely keep a close eye on those and make our best predictions for the upcoming year.

We do have some early data from last year's flu vaccines. Preliminary estimates from last year's influenza season points to pretty high efficacy for the ‘24-’25 flu season. You know, so far we're seeing that, last year, flu vaccine effectiveness was around 32% to 60% effective for those in the outpatient setting or ambulatory setting, and then, you know, 40% to 70% effective against hospitalization.

So those are pretty good numbers. I'm happy with those. And it shows us that the flu vaccine conferred pretty robust protection from last year.

For more, check out Interim Estimates of 2024–2025 Seasonal Influenza Vaccine Effectiveness — Four Vaccine Effectiveness Networks, United States, October 2024–February 2025.

Other Related Content

[04:33] Justin Venneri: And you mentioned, you know, monitoring the strains to try to predict which ones would be the right ones. What factors influence the vaccine effectiveness generally, broadly speaking?

[04:43] Libbi Green, PharmD: Great question. So the circulating strains is certainly a big factor in determining the effectiveness of the vaccine for the season. You know, generally the flu vaccine is a pretty good match, but things can change over the course of the season.

As the influenza season runs along, mutations can occur. It's possible that a circulating virus that had pretty low numbers that wasn't included in the vaccine could take over as the predominant strain. So it's always a possibility. You know, we're looking into our crystal ball, might be a little foggy, but generally it's a pretty good match for the vaccine itself.

Other factors that can affect the effectiveness of the vaccine is timing. So, you know, we touched on how important timing is. You want to get your vaccine at the beginning of the season. If you get it too early, you know, say in August or September. It's possible that your protection might not last through the end of the season versus, you know, getting it too late in the season.

You want to make sure you have enough time to respond to the vaccine and build immunity before you're exposed to the flu virus itself. And then lastly, you know, individual characteristics can affect how different people respond to the vaccines. Those who are immunocompromised, who have comorbidities, or elderly individuals. They can all have varying responses to the vaccine. That's why high dose or adjuvant vaccines are recommended for seniors to help boost their immune responses to the flu vaccines.

[06:21] Justin Venneri: Okay, and there have been some regulatory updates lately. Can you walk us through those?

[06:26] Libbi Green, PharmD: Yeah. Vaccines have been a really hot topic in the news as of late. You can't avoid opening up a webpage without seeing some conversation about vaccines in the headlines. Good news though: the annual flu vaccine is still recommended for all individuals over six months for every flu season. So our federal agencies, ACIP and the CDC, are recommending the annual flu vaccine. They are emphasizing single dose formulations that are free of preservatives wherever possible. And the flu vaccine remains a routine vaccination that's covered under the Affordable Care Act with no cost sharing to patients. So no big changes there, just some tweaks in the delivery and supply chain considerations for those preservative free vaccines.

[07:20] Justin Venneri: And are there state-specific considerations that employer plan sponsors or plan members should consider? States could be different from the Federal, right?

[07:28] Libbi Green, PharmD: Yes. And you know, states have a lot of freedom in how they choose to structure their vaccine policies. And they can vary pretty widely from federal regulations. Vaccine policy can vary state to state, such as mandates for vaccination for schools or workplaces. They can also vary in their coverage.

You know, with some states, such as Massachusetts recently requiring coverage for all vaccines recommended by the state's department of health even if federal guidelines do change. So offering some enhanced protections for vaccines there at a state specific level for our plan sponsors. This landscape means your flu program can't be one size fits all across multiple states within your organization. And it's important to partner with your PBM to ensure patients have the access that they need and that you're meeting all regulatory compliance on your end.

[08:29] Justin Venneri: That makes sense. And I have to ask about COVID and co-administration. There was a lot of discussion about combination vaccines and related topics of last year and previous years. Has that changed at all? And what's the broader general guidance there?

[08:42] Libbi Green, PharmD: Yeah, I think last year we talked about some clinical trials that were underway that were looking at combination products combining COVID vaccine and flu vaccine into one shot. Those trials are still underway. Nothing has been approved for this season. So the flu vaccine is still a standalone vaccine, as well as the COVID boosters. You can receive them together within the same visit. Public health guidance supports vaccine co-administration where indicated doing so, you know, in one appointment is generally an efficient way to simplify logistics for patients.

It's an individual choice that should be made with your provider as a shared clinical decision making. But it does, you know, make it an easy option for patients looking to streamline their healthcare services.

[09:35] Justin Venneri: And just out of curiosity, forgive me if this is a silly question, but like timing, is there a difference? Is there any data that shows when someone should or shouldn't look into the combination? Is there really like a quote unquote Covid season, or just depends on an individual's preference?

[09:51] Libbi Green, PharmD: There's different preferences, different guidance. Generally the COVID season follows the influenza season. As far as the timing goes, it coincides, you know, with back-to-school individuals, you know, getting together in larger groups.

But there may be considerations for high-risk individuals to receive a COVID booster outside of that timeline, you know, depending on their most recent booster or most recent illness with COVID.

So again, you know, that's up for discussion with your provider to reach a shared decision there.

[10:29] Justin Venneri: Makes sense. And then just again, you have a young child at home, I've got three. RSV is always like, oh boy, who's getting sick next? RSV and other vaccines - just curious, is there guidance for these or is that changing, some of that up in the air too?

[10:41] Libbi Green, PharmD: No changes on that front. There was a newish RSV product for infants for their first RSV season. It's not a vaccine, it's a monoclonal antibody. There has been really great data that came out from last year's RSV season that showed that the monoclonal antibody provided really great protection, reduced hospitalizations for infants in their first RSV season.

We do have RSV vaccines that are indicated for pregnant women during RSV season if they are later in their pregnancy, as well as for seniors. Those guidelines have not changed. So, we still have those in our arsenal for RSV protection.

[11:26] Justin Venneri: Okay. And another reason aside from just sharing good information and I wanted to chat with you again, is that plan sponsors out there, they are impacted by uncertainty or changing guidelines. And I think there was a recent Mercer article that was pretty balanced, in my opinion. I'll link that in the show notes too, had some helpful perspective and links in there.

What do you think is important for plans to know about what's going on?

[11:48] Libbi Green, PharmD: You know, flu vaccine especially is classic prevention. We have many years of data showing that flu vaccination reduces medical visits, decreases hospitalizations, and helps mitigate workforce disruption - whether that's absenteeism or presenteeism, folks going to work but not able to perform at their best while they're suffering through the flu.

From a cost perspective, preventing even a small number of hospitalizations offsets vaccine program costs pretty easily. Generally, we see employers covering flu vaccines in both the medical and the pharmacy benefit. This way it improves access and patients have more options for receiving their care.

And then if there are regulatory or guidance changes that impact vaccinations and coverage, I think we're in a unique spot because of Judi®, the claim administration side is no problem. We have a lot of flexibility there to be able to adapt as needed.

[12:55] Justin Venneri: Well, that is a great overview. Thank you so much. Libbi, last question for you today. And as a reminder, we have to keep our compliance hats on and hopefully it's a safe story you can share. What's the most astonishing thing you've seen or think is an interesting thing you've seen that you can share related to our discussion today on flu season?

[13:12] Libbi Green, PharmD: Gosh, that's a great question. Just how nimble our U.S. health system can be in the face of a pandemic, an epidemic, you know, just putting all resources to use for achieving the goal of creating a vaccine for a brand-new illness.

You know, this year I think that's still very applicable. I'm pro-pharmacy. I'm a pharmacist. So, you know, pharmacists are your trusted neighborhood health professionals. We're very accessible, and I know at least in my area it's been tough because we've had a lot of consolidation with some of the larger pharmacy chains closing. And there has been an unmet need in these communities for folks to be able to receive preventive care in the form of vaccines.

So, you know, support your local pharmacy and utilize your pharmacist as a trusted resource for vaccine questions and use them as a resource to go get your vaccine instead of scheduling an appointment with your doctor's office several months out.

[14:15] Justin Venneri: It is American Pharmacist Month, right? So it's a good plug for pro pharmacies.

Libbi, thank you so much for taking the time today. Really appreciate the update and your insights and look forward to staying in touch and hopefully having you back on.

[14:26] Libbi Green, PharmD: Thanks Justin.

‍