Vaccine Pricing and Payment

Vaccines are the most cost-effective and life-saving intervention of modern medicine.  They are the most effective public health measure of the past century and save $10 billion in direct costs and $43 billion in indirect costs each year.

Among the children born each year, immunizations prevent 14 million cases of diseases and avert 33,000 disease-related deaths.

However, the public's ability to get their vaccinations from their primary care physician is threatened. Health plans use inadequate and inconsistent methods for paying physicians to give immunizations - especially as new and more expensive vaccines are added to the immunization schedule. Many primary care physicians cannot afford to offer the new vaccines to their patients. Physicians soon may be forced to stop administering common childhood, adolescent, and adult vaccines. These patients then have to seek vaccinations elsewhere, further fragmenting their medical home and increasing the possibility of an outbreak of an otherwise preventable communicable disease.

Medicine's 2009 Agenda 

  • Require health care payment plans to cover the cost of vaccines and to pay for the associated administration and overhead costs.
  • Require the federal government to purchase child, adolescent and adult vaccines and distribute them to physicians similar to the Vaccines for Children (VFC) program.
  • Require health insurance plans to match their "we support prevention" rhetoric with action. Health plans should be required to reimburse adequately for required and recommended vaccines throughout patients' lives. They must stop looking at vaccines as a "medical loss" but rather as a means of preventing disease and reducing health care costs.

Medicine's Message 

  • Health insurance plans only pay for some of the cost of vaccines and administration, which includes physician work, practice expense, and professional liability insurance. In addition, they rarely cover overhead costs for storing, insuring, and handling vaccines and recording data into a vaccine registry.
  • Physicians in private practice continue to administer immunizations at a loss. Private practices can no longer afford to subsidize health plans or government health programs to immunize the public.
  • Even though their direct costs are lower, public health departments are struggling to meet the demands of vaccinating the uninsured and the underinsured.
  • Inadequate payment takes a toll on public health, resulting in increased infectious diseases, health care costs, and death - all of which could be prevented. 

 


 

2009 Federal Legislative Issue Briefs  

U.S. Congressional main page  


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