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HPV vaccine cost reimbursement could hinder vaccine access, study suggests
IMAGE: DR. KALYANI SONAWANE INVESTIGATED DIFFERENCES IN REIMBURSEMENT RATES FOR THE HPV VACCINE. view more
CREDIT: CLIF RHODES/MUSC HOLLINGS CANCER CENTER
Bare minimum reimbursement rates could be a factor in why some clinics may be struggling to offer HPV vaccination in the U.S.
MUSC Hollings Cancer Center researcher Kalyani Sonawane, Ph.D., and a team of researchers from South Carolina and Texas decided to quantify private insurance reimbursement rates for the HPV vaccine after several qualitative studies noted that health care providers were dissatisfied with HPV vaccine reimbursement by private insurance companies.
The results of their investigation were published July 24 in the Annals of Family Medicine.
They found that non-pediatric specialties were reimbursed at lower rates compared with pediatricians.
Although all specialties received at least the minimum payment recommended by the Centers for Disease Control and Prevention, that rate covers only the cost of the vaccine itself, Sonawane said.
Family medicine doctors received an average of 34 cents above the recommended rate, which would have to cover all of the indirect costs of vaccination, like storage, administration, insurance and record-keeping. In contrast, pediatricians received an average of $5.08 above the recommended rate.
“Family physicians – who are so critical and important, especially in rural areas where not all patients have access to pediatricians – are not receiving adequate reimbursement for the HPV vaccine, which is sort of a disincentive for them to offer this critical cancer-preventive vaccine,” Sonawane said.
“We did find that the number of doses administered by each specialty was slightly sensitive to the reimbursement level or the margin that they were receiving through the reimbursements, and family physicians were most sensitive to the change in reimbursement,” she added.
The HPV, or human papillomavirus, vaccine is recommended for adolescents at age 11 or 12, although it can be given starting at age 9 and up to age 45.
It protects men and women against HPV strains that can cause six types of cancer. The Healthy People 2030 goal is to have 80% of adolescents up to date on HPV vaccines by then. Right now, about 62% are up to date.
After lagging behind other states, South Carolina is now on par with national averages. Hollings has made a special effort to increase HPV vaccination rates, launching a statewide campaign in 2019 to improve them.
In 2021, Hollings launched the Community Health Van, which travels across the state offering HPV and other childhood vaccines as well as cancer education.
Sonawane suspects that the lower reimbursement rates for family physicians could contribute to geographic disparities in vaccination rates. Adolescents in rural areas are less likely to be up to date on vaccines than those in urban or suburban areas. Part of the issue is parental hesitancy about vaccines, she said. Lack of availability, though, if doctors in rural areas don’t stock the vaccine, could be another barrier.
“The key message here is that, yes, we are meeting the minimum threshold that the CDC has put out there, but that may not be enough to sustain vaccination programs, particularly in family medicine clinics,” she said.
About MUSC Hollings Cancer Center
MUSC Hollings Cancer Center is South Carolina’s only National Cancer Institute-designated cancer center with the largest academic-based cancer research program in the state. The cancer center comprises more than 130 faculty cancer scientists and 20 academic departments. It has an annual research funding portfolio of more than $44 million and sponsors more than 200 clinical trials across the state. Dedicated to preventing and reducing the cancer burden statewide, the Hollings Office of Community Outreach and Engagement works with community organizations to bring cancer education and prevention information to affected populations. Hollings offers state-of-the-art cancer screening, diagnostic capabilities, therapies and surgical techniques within its multidisciplinary clinics. Hollings specialists include surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, psychologists and other clinical providers equipped to provide the full range of cancer care. For more information, visit hollingscancercenter.musc.edu.
JOURNAL
The Annals of Family Medicine
ARTICLE TITLE
Reimbursement for HPV Vaccine Cost in the Private Sector: A Comparison Across Specialties
ARTICLE PUBLICATION DATE
24-Jul-2023
COI STATEMENT
A.A.D. reported receiving a consulting fee from Merck on unrelated projects. K.S. has provided consultancy to Value Analytics Labs on unrelated projects. All other authors declare no competing interests.
Family medicine physicians receive lowest HPV vaccine cost reimbursements compared to pediatricians, internal medicine doctors, nurse practitioners and other specialists
Reimbursement for HPV vaccine cost in the private sector: a comparison across specialties
Peer-Reviewed PublicationHuman papillomavirus (HPV) vaccination coverage has improved in the United States, but privately insured adolescents have lower initiation and completion rates compared to those under public insurance programs. One of the contributing factors to this disparity is the higher cost of the HPV vaccine compared to other routinely recommended adolescent vaccines. While private payers typically reimburse the cost of the HPV vaccine at or above the CDC list price (i.e., $210.99 in 2017-2018), it remains below the American Academy of Pediatrics' recommended price (i.e., $263.74). Adequate reimbursement for vaccine costs by third-party payers plays a critical role in enabling doctors and other medical staff to offer and continue providing vaccines.
Researchers investigated the reimbursement rates for HPV vaccine costs across various medical specialties, including pediatricians (as the comparison group), family physicians, internal medicine specialists, nurse practitioners, and other medical practitioners. Additionally, they examined whether the reimbursement amounts were associated with the number of HPV vaccine doses administered by these health care practitioners.
The study analyzed data from over 34,000 unique practitioners and found that family physicians had the lowest net returns per dose ($0.34), while pediatricians had the highest returns ($5.08). On average, during 2017-2018, pediatricians received higher reimbursement for HPV vaccine costs ($216.07) compared to family physicians ($211.33; p<0.0001), internists ($212.97; p<0.0001), nurse practitioners ($212.91; p<0.0001), and 'other' practitioners ($213.29; p<0.0001). The researchers also observed that a one-dollar increase in return was associated with a slight increase in HPV vaccine doses administered, particularly among family physicians (0.08% per dollar). Although reimbursement for HPV vaccine costs by private payers is considered adequate, according to the authors, the study highlights that non-pediatric specialties have a very marginal return on investment, which may be insufficient for covering indirect expenses for stocking vaccines (storage cost, personnel cost for monitoring inventory, insurance, waste, and lost opportunity costs). The authors argue that this makes them more sensitive to changes in cost reimbursement, emphasizing the need for an increase in reimbursement rates for these practitioners so that they can continue offering the cancer-preventing HPV vaccine.
What We Know: The human papillomavirus (HPV) vaccine is the most expensive of all routinely recommended pediatric vaccines. Adequate cost reimbursement by third-party payers is important for helping practitioners continue to offer the vaccine.
What This Study Adds: Researchers determined that net returns from HPV vaccine cost reimbursements are lowest for family physicians ($0.34/dose) and highest for pediatricians ($5.08/dose). Furthermore, a one dollar increment in return was associated with an increase in HPV vaccine doses administered (highest for family physicians; 0.08% per dollar). Although reimbursement for HPV vaccine costs by private payers is generally adequate, according to the authors, non-pediatric specialties face very marginal returns on investment. The authors argue that specialties with narrow returns are highly sensitive to changes in cost reimbursement, and therefore, are worthy of increased reimbursement.
Reimbursement for HPV Vaccine Cost in the Private Sector: A Comparison Across Specialties
Kalyani Sonawane, PhD, et al
Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
Permanent link
JOURNAL
The Annals of Family Medicine
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