Vaccines: 2009-H1N1 Influenza NVAC Vaccination Program Financing

Assuring Vaccination of Children and Adolescents without Financial Barriers

A Report of the National Vaccine Advisory Committee

I. Purposes of this report

In September 2006, the National Vaccine Advisory Committee (NVAC) formed a Vaccine Financing Working Group (VFWG) to examine the current state of financing routinely recommended vaccinations for children and adolescents in the United States, to define any financial barriers to effective delivery of vaccines, and to explore policy options to address these barriers. This Report contains NVAC recommendations based on the Working Group’s findings and conclusions, and includes recommendations developed by the NVAC Adolescent Working Group. It takes into account public comments and extensive stakeholder input received. The overall goal of the Report is to ensure that all children and adolescents have access to all routinely recommended vaccinations without financial barriers.
 

Concerns about the stresses on the vaccine financing and delivery system are widespread but often anecdotal. There is a need to better define the root causes and the magnitude of the problem in the current public and private sector vaccine financing system in the U.S. Among the questions of interest are:
 

1) In light of the number of new child and adolescent vaccine recommendations made since 2004, is the existing system of public sector financing for vaccine purchase and administration optimal to support both current and future vaccination schedules?

2) What does it cost physicians and other clinicians to vaccinate children and adolescents?

3) What financial reimbursements do physicians and other clinicians receive for vaccinating children and adolescents?

4) Based on costs and reimbursements, is the current business case for providers delivering pediatric and adolescent vaccines favorable or unfavorable?

                        How has the business case changed in light of newly recommended vaccines?

                        Is the concern that some providers will cease to administer vaccines justified?

5) What factors are most important in determining the costs associated with vaccines and vaccine administration?

6) What are the roles of governments, vaccine manufacturers, insurers and healthcare purchasers, and consumers in financing vaccines for children and adolescents?

 

Given the limited amount of data to address the questions above, the purposes of this Report are twofold. First, current challenges in child and adolescent vaccine financing and delivery in the public and private sectors are described. These challenges are viewed from the perspective of key stakeholders: physicians and other clinicians; vaccine manufacturers and distributors; insurers, employers, and other health care purchasers; consumers; and state and local governments; all of which had representation on the VFWG. In a number of cases, collection of primary data on the current vaccine delivery system was necessary to answer the questions outlined above.

Second, recommendations for addressing these challenges are identified and discussed.
 

These recommendations are directed to various stakeholders – policy makers in government, health professionals’ organizations, and industry groups – to ensure access to vaccines recommended for routine use among children and adolescents without financial barriers. These recommendations are meant to be consistent with a policy environment that promotes both continued investment in developing new vaccines and new vaccine technology, and continued access to affordable health insurance for all children and adolescents, with coverage of vaccination benefits as defined in health insurance plan contracts and paid by employers through health insurers. These recommendations, if implemented, should also serve to end what has become an ad hoc prioritization of universally recommended childhood and adolescent vaccines taking place throughout the U.S. based on financial considerations, described in further detail below.