Physicians Seek Advance Payment for Some Vaccines
The rising number of recommended, high-cost immunizations has pushed some pediatricians to begin restricting or refusing to administer certain vaccines unless patients pay in advance, the San Francisco Chronicle reports.
For example, the East Bay Pediatrics Medical Group, with offices in Berkeley and Orinda, notified its 1,800 patients who are members of Blue Shield of California that the practice would require them to pay out-of-pocket for four specific immunizations beginning on Aug. 1.
The vaccines were:
- Gardasil, for the human papillomavirus, which has been linked to cervical cancer;
- RotaTeq, for rotavirus;
- Menactra, a new form of the meningococcal vaccine; and
- Prevnar, for pneumococcal disease.
Myles Abbott, a pediatrician with the group, said patients can seek reimbursement from their insurers.
John Yao, Blue Shield's senior medical director, said the insurer fully reimburses physicians for more than a dozen common vaccines, but the high cost of newer vaccines forced the insurer in July to reduce reimbursement levels for the four vaccines.
The new rates give physicians a profit margin of at least 5%, compared to 20% to 30% for more common vaccines.
Physicians argue, however, that even if the price of the medication is reimbursed, insurers do not adequately reimburse for the cost of administering the vaccine.
Physicians also have criticized insurers for not raising reimbursement levels, alleging that insurers' payments to doctors have not kept pace with rising vaccine prices.
Claire Hannan, executive director of the Association of Immunization Managers, said if physicians stop administering certain vaccines, they will shift the burden to public health officials to provide those services (Colliver, San Francisco Chronicle, 9/21). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.