The Board of Health at its meeting Monday evening discussed complications with insurance billing for Shingrix that may affect the Health Department’s ability to distribute the shingles vaccine.
Shingles is a painful rash that can occur in people over the age of 50 by the reactivation of the same virus that causes chickenpox, according to the Mayo Clinic website.
Public Health Nurse Simone Carter explained that “there’s a lot of marketing about how Shingrix is covered by Medicare.” But she said that the copay is covered only for those who have Medicare Part D.
“The long and short of it is that if we want to offer Shingrix here for anyone who is over the age of 65 and is retired, do we as the Health Department want to contract a third-party biller to bill all these supplements?” Carter asked. “Or do we want to move forward as a town with a fund of sorts?”
She stressed that if the town wants to encourage residents aged 50 and over to get the shingles vaccine, not everyone between the ages of 50-65 may have health insurance, and those 65 and older may not have a supplemental insurance plan with their Medicare.
Carter suggested a fund to pay for Shingrix doses for those who are not covered by insurance, but she wanted to seek the board’s guidance about billing.
Said Carter: “I can suck all of that up, but that gets into a different role for me.”
Board chair Lisa Whittemore agreed, noting that billing all the different insurance companies and Medicare plans can become “another full-time job.”
“I also agree with you that if this is something that we are going to offer to the community that we ought to offer it to everyone and not determine eligibility by payer,” she continued, asking what the projected cost might be.
Carter said that she would have to take a look at census data and compare age and income information to make an estimate of the cost.
This is one reason why the department’s strategic plan needs to be discussed and implemented as soon as possible, Whittemore said, to analyze if this is part of the department’s future mission. She also noted that the town’s budget is expected to be tighter over the next few years.
Health Department Director Shaun McAuliffe noted that a regional entity may be able to provide outside funding.
Member Richard Jacobs said his concern was manpower, noting that the department “may be biting off more than it can chew.”
Carter responded that shingles is much less prevalent than COVID-19 and affects a smaller population.
Whittemore said she was unsure what the demand would be for Shingrix from the Health Department. It is available at pharmacies.
Said Whittemore: “I am really loathe to set up third-party billing.”
The vaccine costs $360 per series, according to Carter.
“I think we need a lot more due diligence on this before we go ahead,” Whittemore said.
Strategic plan discussion delayed
McAuliffe noted that the discussion on the department’s strategic plan had to be delayed again because Morgan Clark, the public services manager for the Edward J. Collins Jr. Center for Public Management at the University of Massachusetts Boston who was going to be assisting on the development of the strategic plan, could not be reached since the last meeting.
“I have to say that, if we have not heard from her by the next meeting, I think we need to have a discussion on how we proceed with the strategic plan,” Whittemore said.
Health Department internship program flourishes
McAuliffe announced that the Health Department’s application was approved last week by the state’s Department of Public Health to host at least one intern during the summer through its Local Health Internship Program. Run through the Massachusetts Department of Public Health (MDPH) Division of Epidemiology, graduate students will work on a project with the department. Topics may include environmental health, bioterrorism, communicable disease case investigation and substance abuse prevention, among others. Fifteen other towns statewide are participating in this paid internship program.
McAuliffe noted that the state has commended Hopkinton’s internship program. The research that Talia Feldscher, last year’s intern, has performed on perfluoroalkyl and polyfluoroalkyl substances (PFAS) now is being shared by MDPH, he said.
He added that there are projects that the MDPH would like to see accomplished, “and they see Hopkinton as a vehicle to get these things done.”
Said McAuliffe: “Our interns are doing well.”
COVID-19 emergency period to expire May 11
Carter explained that the federal government determined that the COVID-19 public health emergency period will expire on May 11. This will affect the amount of data shared about the virus, and the availability of vaccines will change when their distribution is privatized rather than federally funded.
“At the end of the day, COVID is a lot more transmissible and a lot more serious, more deadly,” she said. “It takes more lives than the flu does.”
She added that this will affect Supplemental Nutrition Assistance Program (SNAP) recipients.
Carter also announced a new program where vaccine consultation appointments can be set up. This is expected to aid people in ensuring that their vaccines are up to date.
She also noted that she recently distributed 20 cases of COVID-19 test kits in two days.
Project Just Because could get boost
McAuliffe said the department has been working with Project Just Because, a local nonprofit that distributes food and household necessities, to apply for a food insecurity and infrastructure grant from the state. If received, he said it will allow Project Just Because to taken in 28-32 more pallets of food per week.
The number of people receiving food from Project Just Because has skyrocketed to over 820 people per week, he noted.
Said McAuliffe: “They have an opportunity to greatly expand this program.”
He added that the School Department recently reached out to him. Because the schools are mandated to provide as many cold meals as hot meals, cold meals have been going to waste because students are choosing hot breakfasts and lunches.
“What we’re going to work out with them is how to recover items like yogurt, string cheese, milk and fresh fruit to transport it either to Project Just Because or the YMCA after-school program to use as FDA-approved snacks.
Public hearing to address regulation of tobacco sales
McAuliffe said that Hopkinton’s tobacco sales regulations need to be updated to conform with the state’s 2022 regulations, which recently were revised.
The changes will be added to Hopkinton’s existing regulations, he explained. There will be a public hearing scheduled to review the changes after the board reviews the final draft at the next meeting on March 13.
“It fits well with our existing regulations,” McAuliffe said, adding that the state regulations cannot be modified.
Whittemore suggested creating a one-page fact sheet that specifies the changes to the town’s policy that are to be debated.
Future meetings scheduled
The board scheduled its upcoming meetings for the following dates: March 13, April 3, April 24 and May 8. Whittemore noted that a new member will be joining the board after the Annual Town Election on May 15. She also said that the state of the Massachusetts health emergency regarding the COVID-19 pandemic is slated to end on March 31, which may affect in-person meeting requirements. She noted that “there is a lot of work being done at the State House to get it extended.”
Whittemore cited concerns about finding meeting space if the virtual meeting requirement is lifted, as well as the ability of members to attend in-person meetings.