A physician writes to the WSJ:
This vaccine costs pediatricians $120 per dose. When vaccines cost $10 and payers paid $12; that was manageable. Now that the cost is $120 per dose, payers still think it reasonable to pay $122 per dose. They argue that we make a profit as long as they pay us at least our cost, although many pay less. Anyone who runs a business realizes that this is pure sophistry. Due to our enormous overhead costs, we must receive 17% to 28% above the wholesale cost simply to break even. It would cost $2 million to provide this vaccine in our large practice. We would have to borrow that much capital for a “return” of perhaps $2.04 million. We would lose less by keeping that money under a mattress. As a small business, we can’t justify that expense.
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{ 8 comments }
It’s another case of dump on the primary care doc. The Big Pharma company stands to make big profits and mass markets this thing. And peds and FP’s get $2 for explaining HPV, cervical cancer, risks etc to a bewildered and possibly insulted parent…And we(I’m an FP) are expected to stock the item and pay a nurse to administer, record,,, for $2.
This is question, not a comment. Is it possible to simply refuse to give it citing the economics. I think it is. No one says you have to lose money in business.
Anonymous–
Many of us are doing exactly that, refusing to give it. The problem is less of an individual economic one and more of a societal one. When the ACIP, AAP, and other official bodies endorse and recommend a vaccine for general distribution, it is not enough for insurance companies to say “yes, we cover it.” The question is at what price. An insurance plan offering $2 over cost is dishonest and predatory, shifting costs from themselves to the primary care doctor. The American Academy of Pediatrics and others have made clear what would be considered reasonable levels of reimbursement, yet by and large the insurance companies purposefully undercut these numbers for their own bottom line. The insurers are also deceiving their insured patients, letting them believe their doctors are receiving fair reimbursement for a covered product, expecting us to cover for them (which is exactly what happens far too often). As a reminder, we are talking about a tangible product, with a clear and set value, as opposed to a service, which has much more room for negotiation. We can debate what my time is worth, but the price of Gardasil is set firm by Merck.
For those of us who do not take the economic fall for Merck and the insurance companies, where does that leave our patients? Either they are deprived of the recommended vaccine, or they go to the local Health Dept, and now the cost is shifted to the states.
Vaccine delivery in the US is a horrible disconnect between public need and private payment, with providers and patients caught in the middle.
Five years ago when I was still in practice, I made this argument to the managed care companies about vaccines that cost $50 per dose. I was told by one medical director that my contract required me to administer “all recommended vaccines”, and if I did not I could be disenrolled. That was when I began to look for alternatives to private practice. Primary care is being destroyed by all of this, and many of us are leaning out of the window and yelling “I’m mad as hell, and I’m not going to take it anymore.”
Here’s a suggestion to Merck:
Don’t purchase health insurance for your Merck employees that do not reasonably reimburse providers for Gardasil.
Or have Walgreens and CVS stock them and my clinic will administer the medicine for $20 cash.
Applause to the last post: “If the game is rigged, why do you keep showing up?”
Unfortunately, there are suckers applying for primary care residencies, every year! Much get their smarts though, go on to specialty training, and then they can dump back to the lowly left-behinds. Its tough to be in the valley of martyrs…the ivory tower spitting out guidelines weighing on the valley at one side…and the specialists dumping unwanted issues and clients on the other….i should reach for my lexapro now…
I greatly appreciate the 10:12 anonymous post. I was a sucker who believed FamMed could provide a product that served the public, and saved”the system” money. And you’re right. 16 years after residency I have decided I am a sucker. Slow learner, huh?
Well, I STILL believe family docs could solve this problem. I just think the cynicism of the general American public, as you have so well voiced, doesn’t care.People don’t want quality. Or health. They want what they want, NOW.
So I quit. I’m framing houses at 52 and smiling on my way home from work.
My huge concern I have with expensive vaccines is the occasional “oops” factor: dropped vacine, accidently unbilled or uncollected for vaccine, expired vaccine, etc. Those factors have to be considered along with the usual overhead costs of administering a vaccine in a medical office.
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