Reimbursements a Factor in Vaccine Recommendations
Some physicians are refusing to purchase Merck's cervical cancer vaccine Gardasil or are restricting who receives it because they say insurance reimbursements for the vaccine are too low, the Washington Post reports. The issue "highlights a long-simmering dispute over reimbursement for immunization" that has "accelerated as the number of costly new vaccines has proliferated," according to the Post.
Some insurance companies pay doctors $122 per shot for the three-dose vaccine -- $2 more than the price the physicians pay per dose -- which doctors say is not enough to adequately cover the costs of stocking and administering the vaccine.
The problem disproportionately affects pediatricians, who administer more immunizations and are among the lowest-paid specialists, experts say.
Some doctors are providing the vaccine only to those who are insured through plans that will pay a "reasonable" fee for Gardasil, usually about $140 or more per dose. Others write prescriptions for Gardasil, which patients can obtain at pharmacies, and charge a fee for administering the shot.
However, many insurers only pay for vaccines provided by a doctor. The "spotty availability" of the vaccine "is likely to complicate efforts by parents to comply" with laws requiring the vaccine for school entry, the Post reports.
Anne Francis, an associate clinical professor of pediatrics at the University of Rochester School of Medicine, noted that the cost of fully immunizing a child has increased from $150 two decades ago to $1,500 today. Francis added that many small practices are reluctant to pay up front for vaccines when it is difficult to make up the cost of even a single lost dose.
Merck executives say that the cost of Gardasil is justified by the cost of developing the vaccine and the value it provides. In addition, insurers maintain that they provide adequate reimbursement for the vaccine (Boodman, Washington Post, 5/1).