ATLANTA – Concerns about removing financial barriers to childhood vaccination took center stage at an immunization congress sponsored by the American Academy of Pediatrics and the American Medical Association, Dr. Walter Orenstein reported at the summer meeting of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.
One focus of the congress was on recommendations that could be implemented within existing legislation, said Dr. Orenstein, who currently heads a program for vaccine policy and development at Emory University in Atlanta and is a former director of the CDC's National Vaccine Program.
At the meeting, he presented a summary of the recommendations adopted at the congress for improving financing for pediatric immunization. The recommendations remain under consideration by the National Vaccine Advisory Committee; no official document has been produced.
Barriers to adequate vaccine financing include underinsurance, lack of reimbursement, and concerns about vaccine cost, storage, and handling.
But resolving the financial barriers is not enough to ensure high childhood vaccination coverage, and private and public collaboration in vaccine delivery should be maintained, Dr. Orenstein emphasized.
“The best way to ensure continued private sector participation is to [ensure] not only reimbursement for what they do but some reasonable return on the investment beyond cost,” he said.
The congress attendees included approximately 150 representatives from medical and health societies, private providers, insurers, employers, vaccine manufacturers, the federal government, and state and local governments. They agreed that vaccines are different from other disease prevention measures because vaccines protect other members of society in addition to the vaccinees. Consequently, every state must address the financing problem to prevent the development of large clusters of unvaccinated persons, who could spread disease.
Dr. Orenstein presented recommendations from the congress that could guide the medical community's efforts to improve pediatric vaccine financing:
▸ Work with Federally Qualified Health Centers to delegate authority to public health clinics to vaccinate underinsured children through the Vaccines for Children program. This strategy would reduce some pressure on the limited Section 317 funding.
▸ Obtain data on the actual costs of delivering vaccines in private practice settings, so all medical societies could use this data to advocate with insurers for adequate reimbursement.
▸ Work with manufacturers to get better deals for vaccines, especially for new vaccines that cost more up front.
▸ Combine the resources of the American Academy of Pediatrics, American Academy of Family Physicians, and American Medical Association to define the CPT codes for adequate vaccination reimbursement.
▸ Create tax credits for insurers and providers to eliminate underinsurance. The congress attendees agreed that more work was needed to evaluate whether tax incentives would be feasible and help to immunize more children.
▸ Convene a working group to determine whether a federal purchase of vaccines or universal federal funding is worth pursuing.
▸ Acquire the data from the Centers for Medicare and Medicaid Services that were used to develop the current flu vaccine administration fees. If these rates are published and distributed, physicians can use them to advocate for higher fees for other vaccines.
▸ Collect data on the true cost of acquiring and administering combination vaccines. The Advisory Committee on Immunization Practices supports the use of combination vaccines rather than single vaccines whenever possible, but data are needed to show that combination vaccines cost more to administer than do single vaccines and should be reimbursed accordingly.
▸ Obtain data on the best business practices that minimize costs related to vaccines and vaccination, and distribute this information to health care providers.