1. Examining First Dollar Insurance Coverage for Vaccines Michael J. O’Grady, Ph.D. NORC at the University of Chicago Meeting of the National Vaccine Advisory Committee Hubert Humphrey Building Washington, DC February 3, 2010 1 DRAFT - Not for Quotation or Attribution

2. Presentation Project overview Approach Expert interviews Cost analysis Discussion Questions 2DRAFT - Not for Quotation or Attribution

3. Project Overview Working hypothesis: cost is a barrier to vaccination. NVPO contracted with NORC to estimate the costs of extending first dollar coverage for ACIP-recommended vaccines Focus on benefit design implications 3DRAFT - Not for Quotation or Attribution

4. Approach Literature review –Background on vaccination rates and cost sharing policies across payer types Expert interviews –Interviews with payers, researchers, federal officials and private sector leaders Cost analysis –Merging of federal and employer-based data sources on vaccination rates by cost-sharing design. 4 DRAFT - Not for Quotation or Attribution

5. Expert interviews Interviews will address issues like the effects of first dollar coverage on premium costs, immunization rates, and other topics Experts include: –John Bertko, RAND (Retired Chief Actuary, Humana). –Douglas Hadley (Chief Medical Officer - Director Coverage Policy Unit, CIGNA). –Ronald Gresch, (Chief Health Actuary, FEHBP). 5DRAFT - Not for Quotation or Attribution

6. Cost Analysis Three key areas –Data 2008 National Immunization Survey (NIS) 2006 MarketScan employer claims data –Analysis Use the claims data to estimate the coverage differential between cohorts with 1 st $ and cohorts with cost-sharing. Simulate the implementation of the recommendation. Estimate the new post-implementation coverage rate. Estimate the cost of implementation. Transparent and replicable. 6DRAFT - Not for Quotation or Attribution

7. Distribution of Children Ages 18 to 35 Months by Insurance Coverage 7 DRAFT - Not for Quotation or Attribution

8. Table 1 - MMR Vaccination Indicator by Health Insurance Coverage* MMR Vaccination Indicator Employer Health Coverage Medicaid/ SCHIP Indian Health Service Military Health System Other Health Coverage UninsuredTotal First Dollar Some Cost- Sharing Total No Shots Recorded 180,12055,142 235,262183,5533,9359,50533,75662,393528,403 6.0%24.3% 7.3% 3.9%6.6%8.0%15.8%7.7% Up to Date 2,831,203171,517 3,002,7202,344,16897,544134,678388,810332,9316,300,851 94.0%75.7% 92.7% 96.1%93.4%92.0%84.2%92.3% Total 3,011,323226,6593,237,9822,527,722101,478144,183422,567395,3246,829,256 * There maybe some minimal double counting due to children having multiple forms of insurance. Source: National Immunization Survey (NIS) 2008 and the Watson Wyatt MarketScan. 2006. 8 DRAFT - Not for Quotation or Attribution

9. 9 Employee costs Employer costs Not Vaccinated (24.3%) MMR Financing Relationships – Employer Provided Coverage (with cost-sharing) DRAFT - Not for Quotation or Attribution

10. 10 Employer Costs Not Vaccinated (6.0%) MMR Financing Relationships – Employer Provided Coverage (without cost-sharing) DRAFT - Not for Quotation or Attribution

11. 11 Original Employer Costs Not Vaccinated (6.0%) MMR Financing Relationships – Employer Provided Coverage (eliminate cost-sharing) DRAFT - Not for Quotation or Attribution

12. Table 2 - DTP Vaccination Indicator by Health Insurance Coverage* DTP Vaccination Indicator Employer Health Coverage Medicaid/ SCHIP Indian Health Service Military Health System Other Health Coverage UninsuredTotal First Dollar Some Cost- Sharing Total No Shots Recorded 11,94029,69041,63031,8451801,2546,22210,41591,546 0.4%13.1%1.3% 0.2%0.9%1.5%2.6%1.3% Some Shots Recorded 12,14330,19542,33883,5753,4224,8105,67122,916162,732 0.4%13.3%1.3%3.3%3.4%3.3%1.3%5.8%2.4% Up to Date 2,987,240166,7743,154,0142,412,30197,877138,119410,674361,9936,574,978 99.2%73.6%97.4%95.4%96.5%95.8%97.2%91.6%96.3% Total 3,011,323226,6593,237,9822,527,722101,478144,183422,567395,3246,829,256 * There maybe some minimal double counting due to children having multiple forms of insurance. Source: National Immunization Survey (NIS) 2008 and the Watson Wyatt MarketScan. 2006. 12 DRAFT - Not for Quotation or Attribution

13. 13 Original Employer Costs Not Vaccinated (0.8%) DTP Financing Relationships – Employer Provided Coverage (eliminate cost-sharing) DRAFT - Not for Quotation or Attribution

14. Discussion Implications of extending first dollar coverage to those already paying cost sharing for vaccinations. Understanding of costs to other stakeholders. Moving into older age cohorts. Other compliance mechanisms? Other issues to address? 14DRAFT - Not for Quotation or Attribution

15. Contact: Michael J. O’Grady, Ph.D. Senior Fellow NORC at the University of Chicago O’Grady-Michael@norc.UChicago.edu 15DRAFT - Not for Quotation or Attribution