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Cost of newer vaccines may not be covered by insurance

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Administering vaccines is a component of standard pediatric care. As is often the case, newer forms of treatment are more expensive. A new study has found that physicians are not adequately reimbursed for vaccine administration, leaving them with the choice of either not providing them or requiring the patient to cover the cost of the shortfall. The findings were published online on February 24 in the journal Pediatrics.

The study authors note that, due to high purchase costs of newer vaccines, financial risk to private vaccination providers has increased. Therefore, they surveyed pediatricians and family physicians in regard to their satisfaction with insurance payment for vaccine purchase and administration. The survey was categorized by payer type and the proportion of healthcare providers who considered discontinuing provision of all childhood vaccines for financial reasons. The investigators also evaluated strategies used for handling uncertainty about insurance coverage when new vaccines first become available.

From April 2011 through September 20111, the researchers conducted a national survey among private pediatricians and family physicians. The had response rates of 190/277 (69%) for pediatricians and 181/260 (70%) for family physicians. They found that the level of dissatisfaction varied widely by payer type for payment for vaccine administration (Medicaid (MediCal in California): 63%; Children’s Health Insurance Program: 56%; managed care organizations (HMOs): 48%; preferred provider organizations (PPOs): 38%; and fee for service: 37%). However, the degree of dissatisfaction for payment for vaccine purchase was similar among the groups (HMOs: 52%; Child Health Insurance Program: 47%; PPOs: 45%; fee for service: 41%). About 10% of the physicians surveyed had seriously considered discontinuing providing all childhood vaccines to privately insured patients because of cost issues. The most commonly used strategy for handling uncertainty about insurance coverage for new vaccines was to inform the parents that they may be billed for the vaccine; 67% of the physicians reported using three or more strategies to handle this uncertainty.

The authors concluded that many primary care physicians are dissatisfied with payment for vaccine purchase and administration from third-party payers, particularly public insurance for vaccine administration. They noted that cost issues could result in a healthcare provider discontinuing the administration of all childhood vaccine and that physicians have developed a variety of strategies for dealing with the uncertainty of insurance coverage for new vaccines.

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