AH038 - Navigating Flu Season! A Quick Update on Vaccines and Such, with Libbi Green, PharmD

Transcript

Lightly edited for clarity, sources linked at the end.

[00:27] Justin Venneri: Hello and thank you for joining us for this episode of the Astonishing Healthcare podcast. This is Justin Venneri, your host and Director of Communications at Capital Rx. And in the studio with me today is Libbi Green, a pharmacist on our formulary operations team. And we're going to be talking about flu season. Libby, thanks so much for joining me today.

[00:45] Libbi Green, PharmD: Thanks, Justin. Thank you for having me. It's a pleasure to be on the podcast.

[00:48] Justin Venneri: And it's a timely discussion. Before we get into the basics and background of flu season, Libbi, how about you give us a little bit about your background? What was your path to Capital Rx like? And then what's your role here?

[01:01] Libbi Green, PharmD: Yeah, absolutely. So, I started my pharmacist career in hospital pharmacy at the Children's Hospital of Philadelphia and also the Penn Medicine Health system here in Philly, where I live. I was part of their annual flu vaccine campaigns for employee vaccinations, as well as their Covid-19 clinics in the community. From there, I transitioned to managed care and formulary management, which addresses the list of drugs and clinical applications of medications that might be covered under the pharmacy benefit. I've been at Capital Rx for two years now with the formulary operations team as a formulary operations manager, and in this role, I support our health plan clients with their custom formularies on our adjudication platform, JUDI®.

[01:55] Justin Venneri: Awesome. So this year's flu season, maybe we can take a quick step back. Can you just give us, like, the background of flu season? What are the basics? Why do we care about this?

[02:05] Libbi Green, PharmD: Sure. So, flu season, you know, it generally starts in October and it lasts all the way through May. So like you said, this is a super timely discussion. The flu virus is most active during the colder months, usually peaking between December and February.  

So when's the best time to get your flu vaccine? You know, ideally you want to get vaccinated in September, October. It takes about two weeks for your body to build up immunity after receiving the shot. So you'll want to be prepared before flu activity really ramps up and you want your protection to last through the peak season. Now, why is the flu vaccine so important? It might seem like a minor illness to some people, but it can actually be quite serious, especially for high-risk populations like senior citizens, young children, pregnant women, and people with chronic conditions such as asthma or heart disease. And even if you're generally healthy, getting vaccinated helps protect you and the loved ones around you.

[03:09] Justin Venneri: Got it. So how can you tell in general, like, how bad the flu season might be? Are there some tells?

[03:15] Libbi Green, PharmD: That's a great question. So, the World Health Organization tracks the strains of the flu virus that are circulating globally through a process of predictive analytics. They track flu trends, looking at what's circulating in the southern hemisphere during their winter months. Their flu season occurs, you know, before ours, and that kind of predicts what we can expect in the northern hemisphere for our flu season. They meet to recommend the composition of the flu vaccine for the southern and northern hemispheres. And then the FDA, our health agency body, needs to approve the strains for the US vaccine compositions. For this year, all the vaccines are trivalent, and they consist of two Influenza A like viruses and one Influenza B type virus.

[04:11] Justin Venneri: Interesting. And so, what are some of the caveats there when we think about how many cases we might see this season?

[04:18] Libbi Green, PharmD: Yeah, absolutely. There are definitely limitations to this method, and it's really just our best guess. You know, flu viruses can mutate quickly, and sometimes new strains emerge after the vaccine has been formulated. That's why the flu vaccine isn't 100% effective, but it's our best defense that we have.

[04:38] Justin Venneri: Okay. How effective have flu vaccines been historically? How did it do last year? Any other data you can share?

[04:46] Libbi Green, PharmD: Yeah, it definitely varies year to year in terms of efficacy. Last year's vaccine was about 40% to 60% effective, which is pretty good. It might not sound perfect, but it still significantly reduces the severity of symptoms if you do get the flu. And it also prevents hospitalizations and deaths due to flu illness.

[05:09] Justin Venneri: Are there different formulations of the flu vaccines?

[05:12] Libbi Green, PharmD: That's a great question. Yes, there are different formulations. We have a high dose flu shot and an adjuvanted vaccine specifically for seniors, which contain more antigen to boost their immune response. We also have an intranasal flu vaccine, which is a needle free option, which is nice. And that's typically used for younger, healthier individuals.

[05:37] Justin Venneri: Cool. Also, you wrote a couple of articles last year which were published that I'll link in the show notes. You know, the flu vaccine seems like it's a pretty quote unquote well-oiled machine from a pharmacy supply chain and manufacturing standpoint at this juncture. So once the FDA approves the strains, the manufacturers just ramp up production. Is that just the clockwork at this point?  

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[05:57] Libbi Green, PharmD: Pretty much they. They definitely have it down to the science. Once the FDA finalizes which flu strains will go into that season's vaccine, then the manufacturers get to work. Flu vaccine production is a huge operation, requiring months of preparation. The manufacturing process involves growing the virus strains in eggs or cell cultures, then inactivating them to create the vaccines. So it's a really delicate balance. Production needs to ramp up early enough to meet the demand, but also leave time for final testing and approval. Thankfully, the system works smoothly most years, ensuring enough doses are available for everyone who needs it.

[06:44] Justin Venneri: And how about COVID? And how does that play into the equation? Actually, just the other day I saw Pfizer ad with John Legend getting his flu shot and his Covid shot. So I feel like that at least Pfizer is promoting the need to get vaccinated this season.

[07:01] Libbi Green, PharmD: Covid has been highly prevalent in the news, it feels like for the past couple years, but you don't want to forget about the flu season as well. Now, the FDA and ACIP, they recommend to get the annual seasonal vaccine together for both Covid and flu at this time of year to protect you for the upcoming cold and flu season. There has been talk of a combination vaccine, one that protects against both flu and Covid in one convenient shot. While that would be great and, you know, would certainly cut down on the number of vaccines you might have to get each year, we're not quite there yet. Manufacturers are working towards it, but the earliest we might see a combo vaccine is likely next year. But in the meantime, it's completely safe to get both your flu and your Covid vaccines at the same visit, like John Legend did in the commercial, it sounds like. And that way, you know, if you're eligible to receive both of those, knocking them both out in one appointment saves you time, and then you're boosting your immunity against two serious viruses at the same time.

[08:21] Justin Venneri: And it can be a bit of a polarizing issue, and people have different reactions or concerns about the vaccines.

[08:30] Libbi Green, PharmD: Now, if you're thinking about which vaccine is right for you, talk to your healthcare provider, talk to your pharmacist about your specific situation, and they'll help you make that choice for you personally.

[08:46] Justin Venneri: I guess allergies play a role, right?

[08:48] Libbi Green, PharmD: Yeah, absolutely. And that's why we have different formulations of vaccines available. You know, some are grown in those egg-based environments. So, if you have an egg allergy, your pharmacist or healthcare provider would recommend a different formulation for you, depending on the delivery vehicle.

[09:10] Justin Venneri: Okay. And then one more just general question. I think a lot of people know some of the locations they can go to get a flu shot or a Covid vaccine. And Covid obviously put a lot of strain on pharmacists, especially retail pharmacies, with testing and the administration of vaccines. Can you share your thoughts on people getting their flu shots at pharmacies or other locations?

[09:32] Libbi Green, PharmD: Yeah, I think it's a great option for patients. You know, when we're thinking about convenience here, you don't need to schedule a doctor's appointment necessarily to get your flu shot or your Covid shot. Many pharmacies offer flu vaccines, and in some states, even pharmacy students or pharmacy technicians could administer it, in addition to pharmacists, who are all highly trained and authorized to administer them. And the nice thing about pharmacies are they're highly visible and accessible in the community, and they make it easier for people to get vaccinated without waiting for that doctor's visit. And that ease of access has made pharmacies a vital resource really in boosting flu vaccination rates across the country.

[10:19] Justin Venneri: Got it. So that covers the background of flu season and vaccinations pretty nicely. Can we get into the pharmacy benefits perspective a little bit here? What should plan sponsors think about for their members as it relates to flu season and vaccinations?

[10:35] Libbi Green, PharmD: From a pharmacy benefit perspective, flu vaccines are viewed as essential preventive care. Plan sponsors recognize the enormous value in covering flu vaccines. Each year, thousands of hospitalizations and deaths are prevented because of flu vaccines. So they're an amazing tool in our arsenal in terms of public health and prevention. We also have the American health agencies, like the CDC and the ACIP, strongly recommending annual flu vaccination as a preventive measure for everyone six months and older. So not only does it protect individuals, but from a pharmacy benefit perspective, it reduces healthcare costs overall by decreasing medical visits, prescription utilization, and hospitalizations.

[11:30] Justin Venneri: And is it just automatically added to, like, standard formularies, or how does that work?

[11:35] Libbi Green, PharmD: So here at Capital Rx, the new seasonal flu vaccines are added to our standard formularies every year. Plan sponsors do have the option to carve vaccines out, as some do under the medical benefit instead of the pharmacy benefit. Additionally, some employers have flu vaccine campaigns or might sponsor flu clinics for their employees on site.

[12:00] Justin Venneri: Oh, that's nice. Is there typically a copay or cost associated with them, or does that just depend on the plan?

[12:06] Libbi Green, PharmD: It can depend on the plan, but the overwhelming majority of plan sponsors will cover them without a copay, making them super accessible for all members.

[12:17] Justin Venneri: Okay. Are there any new formulations in pipelines or advancements to look forward to? You mentioned that maybe we'll see a combination in the next year or so. Is there anything else you're tracking? I know Moderna was working on something.

[12:32] Libbi Green, PharmD: Yeah. So Moderna was working on an mRNA formulation of the flu vaccine and, you know, to your point, hoping to combo it with a COVID vaccine -- with their mRNA COVID vaccine. Unfortunately, it didn't look like the efficacy met the standard for clinical trials, so we did not see it this year. But there's still a lot of exciting things in the pipeline. You know, researchers have been working on novel formulations for several years now that might improve efficacy of flu vaccines down the road. Some of those options include a universal flu vaccine that targets broader portions of the virus. So that would make it effective against multiple strains and make it less susceptible to mutations throughout the year. So potentially we could even be looking at a flu vaccine that lasts longer than one season, which would be amazing, right?

[13:33] Justin Venneri: That would be great, especially for folks that don't like getting shots.

[13:37] Libbi Green, PharmD: Well, and speaking of, there was some additional exciting news this year in advancements for flu vaccines. The FDA did approve the first at home administered intranasal flu vaccine that could be available as early as next year. So that would allow for home delivery of flu vaccines, making it even easier for patients to access those vaccines and access flu protection, you know, outside of a traditional healthcare setting.

[14:09] Justin Venneri: Very cool. Okay, and last question, and I ask everybody that comes on the show, what's the most astonishing thing or surprising thing that you have seen as it relates to our discussion today that you can share, of course?

[14:20] Libbi Green, PharmD: I would say for me it's just how adaptable flu vaccines are. Every year, you know, we adjust the formula to match the circulating strains as closely as possible. The science behind it really is incredible, if you're into those details and the nitty gritty. Even though it's not a perfect match every time, the benefits far outweigh the risks. Plus, the fact that you can get it at your local pharmacy from your pharmacist, usually for no cost, that's accessibility at its finest.

[14:55] Justin Venneri: Got it. Libby, thanks so much for taking the time today. Enjoyed having you on and hopefully we can have you back next year to hear about any updates for flu season 2025.

[15:05] Libbi Green, PharmD: Amazing. Thank you, Justin.

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Helpful Resources

• CDC Flu View - Weekly U.S. Influenza Surveillance Report
• CDC - What to Know About Flu Season

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