Financial barriers may compromise combination vaccine delivery

More than 50% of physicians surveyed from 630 pediatric practices felt that they did not receive adequate reimbursement for vaccine cost and administration and about 20% said reimbursement issues influenced decisions not to use combination vaccines, data from a nationally representative survey presented at the Pediatric Academic Societies Annual Meeting revealed.

Although combination vaccines have the potential to increase vaccination coverage and timeliness, they often cost more than the sum of their parts.

“Pediatricians agreed on the benefits of combination vaccines — that they were safe, effective and provided adequate immunization coverage,” Courtney A. Gidengil, MD, fellow in infectious diseases at the Children’s Hospital Boston and Harvard Medical School, told Infectious Diseases in Children. “The majority are still using them, but there is certainly a subpopulation that is affected by reimbursement issues.”

Survey responders reported the following combination vaccination usage:

Diphtheria toxoid, recombinant hepatitis b, acellular pertussis vaccine, inactivated poliovirus vaccine, tetanus toxoids (Pediarix, GlaxoSmithKline); 70%.
Diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus and Haemophilus influenzae b conjugate, tetanus toxoid conjugate vaccine (Pentacel, Sanofi Pasteur); 20%.
Haemophilus influenzae b conjugate vaccine, hepatitis b vaccine, recombinant (Comvax, Merck); 24%.
Diphtheria, haemophilus influenzae, pertussis, and tetanus vaccine (Trihibit, Sanofi Pasteur); 20%.
Diptheria and tetanus toxoids and acellular pertussis adsorbed and inactivated poliovirus vaccine (Kinrix, GlaxoSmithKline); 13%.
Measles, mumps, rubella and varicella virus vaccine live (Proquad, Merck); 2%.

“Smaller practices, those with higher proportions of patients with private insurance and those in states with less inclusive vaccine financing policies remain less likely to use combination vaccines,” Gidengil said at the meeting.

Conversely, the more inclusive the state vaccine financing policy, the more likely a practice is to use combination vaccines.

Study limitations included participant inability to quantify what adequate reimbursement meant and a potential responder bias, with those who participated possibly predisposed to feel strongly about poor reimbursement. However, Gidengil noted that even if all non-responders had reported adequate reimbursement, the percentage of those who felt finances posed a problem would still remain about 40%. – by Nicole Blazek

These days it seems as if many insurance companies drag their economic feet as long as they can regarding fair reimbursement for new ACIP approved vaccines. They argue that combo vaccines should not cost more than the dollar sum of the parts. Tell that to the manufacturers who almost universally charge a premium price on combos, rightfully based on research and development costs that they have incurred. So once again, the benevolent pediatrician is caught in the middle of this financial game. Each month we purchase and store over a $100,000 worth of vaccines in our seven-person practice. With over 200 insurers' different reimbursement rates, increasing costs and ratcheted down reimbursements, justifying the storage and administration of vaccines for all our patients is becoming much less attractive.

Thus, I can understand why many practices avoid combos and depend on the extra reimbursement from giving four or five individual administration fees to stay afloat with vaccine purchases. The uncertainty is daunting.

As I have stated before, we really need a federal mandate to all insurance companies for a standard 15% surcharge over our vaccine costs, plus a reasonable per-shot administration fee. This economic cat-and-mouse game is too financially risky for us.

– Stan L. Block, MD

Infectious Diseases in Children Editorial Board

For more information:

Gidengil C. #3400.2 Presented at: Pediatric Academic Societies Annual Meeting; Baltimore; May 2-5, 2009.