Assuring coverage with newly introduced vaccines: Perception, Program, & Financing Alan R. Hinman, MD, MPH Subcommittee on Immunization Coverage June 7, 2006

Issues 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 Newer vaccines more expensive than “traditional” vaccines VFC vaccine cost to fully immunize a child 1995~$ ~$850 (with rotavirus but without HPV) 2008>$1,000?

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

Issues 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 Recent expansion in number and costs of vaccines represents a major (but temporary) “bubble” 7.After HPV, there will be a time gap before additional new vaccines are introduced for universal use 8.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