Assuring coverage with newly introduced vaccines: Perception, Program,

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Assuring coverage with newly introduced
vaccinesPerception, Program, Financing

• Alan R. Hinman, MD, MPH
• Subcommittee on Immunization Coverage
• June 7, 2006

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Issues - 1

• Several new vaccines recently, or about to be,
  introduced into routine schedule for young
  children and adolescents
• Pneumococcal conjugate
• Meningococcal conjugate
• Rotavirus
• Human papillomavirus

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Issues - 2

• Newer vaccines more expensive than traditional
  vaccines
• VFC vaccine cost to fully immunize a child
• 1995 150
• 2006 850 (with rotavirus but without HPV)
• 2008 gt1,000?

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Issues - 3

• 3. Limited sources of financing for vaccines
• Public
• Section 317
• VFC
• State/local government
• Private
• Insurance
• Out-of-pocket

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Issues - 4

• Meeting the increasing costs is a major challenge
• VFC covers automatically
• Insurance covers after a short delay
• 317 covers after significant delay
• State/local governments may/may not cover after a
  significant delay (e.g., universal light)
• Underinsured remain uncovered
• 5. Remember that vaccine price is not the only
  cost reimbursement for administration

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Issues - 5

• Recent expansion in number and costs of vaccines
  represents a major (but temporary) bubble
• After HPV, there will be a time gap before
  additional new vaccines are introduced for
  universal use
• If we dont now fix the system we may face bigger
  problems in the future

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Proposal - 1

• Subcommittee on Immunization Coverage should
  address the problem of insurance
  coverage/underinsurance for new vaccines
• Define underinsured
• Ascertain current prevalence of underinsured and
  likely projection for future
• NIS now looking at underinsured
• AHIP survey of members

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Proposal - 2

• Determine attitudes/practices of
  employers/benefits managers/providers
• Engage NBGH
• Engage benefits managers
• Engage providers
• Address reimbursement for providers
• Engage major stakeholders in discussion
• Assure public involvement

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Proposal - 3

• Develop recommendations to assure that all
  persons recommended to receive new vaccines will
  have access to these vaccines without financial
  impediment to themselves or their providers