Economic data supports improved vaccination reimbursement

September 1, 2011

As the focus of managed care strategy includes implementing preventative initiatives, it is critical not to overlook vaccines.

Key Points

AS THE FOCUS of managed care strategy includes implementing preventative initiatives, it is critical not to overlook vaccines. For decades, vaccines have been utilized worldwide, decreasing mortality, especially in poor and third world countries. More specifically, in the past decade, the number of vaccine-preventable deaths in the pediatric population has been reduced by 33% from approximately 3 million to 2 million deaths.

With the pronounced clinical and health outcome benefits of vaccines, coupled with the wide array of vaccine products available, there are three major issues associated with improving utilization rates and realizing the positive impact of vaccines: access; research and development; and provider reimbursement.

Various philanthropic organizations, such as the Bill and Melinda Gates Foundation and the Global Alliance for Vaccines and Immunization, are constantly working to improve patient access to vaccinations and provide opportunities for continued research and development in both the academic and commercial sectors. When discussing the issues of access to vaccines, one must also take into account secondary components of access, such as infrastructure and properly trained personnel. Medical staff, assistants and support staff must understand the complexities of not only implementing a vaccination campaign and/or strategy but the potential public health ramifications that are inherently also a part of such an initiative.

Above all, reimbursement is a major hurdle. Not all managed care organizations adequately cover-or reimburse physicians for-the delivery of vaccines to the pediatric population. In fact, the reimbursement issue is apparent in the state and federal sectors, including Medicaid programs, where the administration fees provided for vaccines might not even amount to covering the cost of the clinician's supplies.

On the private side, some insurers will pay a few dollars above the acquisition cost and then add an administration fee, oftentimes roughly half the total reimbursement for an adult vaccine administration. Financial examples such as these illustrate why physicians and other healthcare professionals that do not practice in pediatrics will rarely administer vaccines to young populations on a consistent basis. In fact, surveys have suggested that some pediatricians may avoid consistent vaccine administration because of the economic downside. The lack of vaccination for children and young adults could signal a public health disaster and dramatically increase the burden of disease in the pediatric population as well as the potential for chronic conditions.