2022/2023 Universal Influenza Immunization Program (UIIP)

Reimbursement for Vaccine Administration

• Fee-for-Service Providers (OHIP)
• Injection-Trained Pharmacists (HNS)
• Health Care Agency-Administered Doses in Pharmacies
• Community Clinics

Fee-for-Service Providers (OHIP)

It is important for the ministry to capture administrative data on influenza immunization for the purposes of program monitoring and evaluation. Therefore, when billing through the Ontario Health Insurance Plan (OHIP), please select the applicable OHIP billing code that is specific for influenza immunization.

Physicians are encouraged to review the delegation requirements in the General Preamble of the Schedule of Benefits for Physician Services prior to holding immunization clinics. Physicians who have concerns regarding these requirements or who have additional questions should contact their local OHIP district office.

Injection-Trained Pharmacists (HNS)

Pharmacists will be paid a fee per eligible claim for publicly funded influenza vaccines administered to eligible Ontarians (with or without a OHIP card) who are 2 years of age and older.

The claim must be submitted through the ministry's Health Network System (HNS) using the assigned Drug Identification Number. The 2022/2023 updated Notice from the Executive Officer will provide further information on Pharmacist Administration of Publicly Funded Influenza Vaccine and Claims Submission using the HNS.

Health Care Agency-Administered Doses in Pharmacies

The pharmacy will be reimbursed $5.00 for each dose of publicly funded influenza vaccine administered through health care agency-administered pharmacy clinics.

For a health care agency-administered pharmacy clinic to be eligible for reimbursement by the ministry all the following criteria must be met:

• health care agency-administered pharmacy clinics must be held within the physical boundaries of the pharmacy;
• the pharmacy must retain the services of a health care agency that has completed the ministry prequalification process to administer publicly funded influenza vaccine;
• influenza vaccine can only be administered in a location that is within the jurisdiction of the local public health unit where the vaccine was obtained;
• clinics must be open to the public (i.e., open and accessible to any eligible vaccine recipient who lives, works or attends school in Ontario) and widely advertised in the community (e.g., local newspaper, posters, etc.);
• only administration of publicly funded influenza vaccine will be reimbursed (e.g., vaccine administered must not be obtained from a private supplier);
• all publicly funded influenza vaccines administered must be provided free of charge to the vaccine recipients; and the ministry must not be billed for the administration of the influenza vaccines through any other mechanism (i.e., the ministry's Health Network System).

Complete a Universal Influenza Immunization Program Pharmacy Form to receive reimbursement for influenza vaccine doses administered during a health care agency-administered pharmacy clinic. Forms should be submitted monthly, with the total doses administered over the month. The form should be submitted to the ministry by the 15th of the following month. Clicking the submit button on the form will automatically send the form to the ministry.

It is the responsibility of the pharmacy owner or pharmacist to ensure that information on the Universal Influenza Immunization Program Pharmacy Form is completed in full prior to submission.

Universal Influenza Immunization Program Pharmacy Forms without a valid Ontario Drug Benefit (ODB) number cannot be paid as the ministry has no other means of providing reimbursement.

Community Clinics (held by government transfer payment organizations)

The ministry will reimburse government transfer payment organizations $5.00 for each dose of publicly funded influenza vaccine administered through community-based clinics open to the general public. Clinics for staff are considered workplace clinics and are NOT reimbursable.

Reimbursable clinics can only be provided by UIIP approved organizations that are in current receipt of government transfer payments (i.e., LTCHs, public hospitals and CHCs) provided that ALL of the following conditions are met:

• The clinic is open and accessible to any eligible vaccine recipient (i.e., anyone who is 6 months of age or older who lives, works or attends school in Ontario);
• The clinic is widely advertised in the community;
• Only publicly funded vaccine must be used;
• Influenza immunization must be provided free of charge to the vaccine recipients;
• Publicly funded vaccine must be both obtained and administered within the jurisdictional boundaries of the same public health unit; and
• The ministry must not be billed for these immunizations through any other mechanism.

Complete a Universal Influenza Immunization Program Reimbursement Form to receive reimbursement for influenza vaccine doses administered during an eligible community clinic. Forms should be submitted monthly, with the total doses administered over the month. The form should be submitted to the ministry by the 15th of the following month. Clicking the submit button on the form will automatically send the form to the ministry.