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

2. Issues - 1 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

3. Issues - 2 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?

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

5. Issues - 4 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

6. Issues - 5 6.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

7. 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

8. 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

9. 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