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This discussion focuses on the introduction of new vaccines, challenges with cost and coverage, and proposals to address insurance coverage and underinsurance issues. Recommendations aim to ensure access to new vaccines without financial barriers.
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Assuring coverage with newly introduced vaccines:Perception, Program, & Financing Alan R. Hinman, MD, MPH Subcommittee on Immunization Coverage June 7, 2006
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
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 >$1,000?
Issues - 3 3. Limited sources of financing for vaccines • Public • Section 317 • VFC • State/local government • Private • Insurance • Out-of-pocket
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
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 don’t now fix the system we may face bigger problems in the future
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
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
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