Poor reimbursement and high cost are reasons why:
Teri Perryman, a doctor in Kerrville, Tex., is not only avoiding Gardasil and RotaTeq, but also not offering the new meningitis vaccine, flu shots or new expensive combination products like one that combines the chickenpox vaccine with the measles-mumps-rubella vaccine, according to her husband, Kevin Perryman, who helps manage the practice.Other doctors are asking patients to pay upfront or, in a new twist, are sending them to the drugstore. Typically, physicians have not written prescriptions for vaccines, as they do for drugs, but instead buy and store them, recouping their money when they give the vaccines to patients.
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{ 6 comments }
I’ve noticed this being the case with Gardasil. We’ve gotten an inordinant number of prescriptions for it. PBMs won’t pay for it, of course, so most of these scripts go unfilled, since patients won’t pay for it on their own.
I figured lack of reimbursement was the reason why…
the answer is the same as is happening with expensive injectables / infusions for oncologists & rheumatologists:
the insurer approves & buys the vaccine, then sends it directly to the doc administering it. This is becoming more common with chemo & biologics, and already happens with Synagis, since it’s like $1000/dose.
This cuts docs out of the financial loop, and is good for two reasons:
1- docs don’t have to advance the funds with little or no return on investment, as with vaccines
2- eliminates any incentive to give e.g. chemo at a markup, thus saving money to the system that might otherwise be spent unwisely.
The idea of insurance paying for vaccines is, in the first place, and oxymoron. Insurance is paying to shift the risk of unexpected expenses. Vaccines are maintenance expenses, not unexpected ones. It is like having auto insurance pay for wax jobs and oil changes.
If a vaccine is considered indicated in all 12 years olds, then to have it covered by insurance is to consider the risk is to be 12 years old. Therefore the premium charged to the parents of 12 year olds will necessarily just increase by the cost to the insurance company of covering the vaccine plus all administrative cost. The only way the parent actually comes our ahead is if someone else (taxpayer?) is paying the premiums or if most people for whom the vaccination is indicated don’t get it. Meanwhile, the doctor is stuck with having the insurance company trying to set the price for something without consideration to his real costs of providing, which must include his risks of unused and expiring stock.
Something so irrational can’t work out well.
Post 2:07 doesn’t have the correct idea. It isn’t the certitude of needing the vaccine that renders the idea of insuring the costs of the vaccine unreasonable, but the value of the vaccine relative to the risk of payout for treatment of the disease without the vaccine being used in its prevention. So there is in fact an insurable risk. It is akin to some auto insurers waiving the deductible requirement for windshield replacement to encourage insured car owners not to delay replacing cracked, and possibly unsafe windshields. The extra cost is weighed against the cost of extra claims.
The problem for the doctor is the issue of balance billing, which is irrational. If the insurer covers $50 but the vaccine costs $100, the extra costs should be levied against the consumer. Clearly if there is some value in the vaccine, patients should be willing to purchase it. But if the insurance company, or Medicare, prohibits balance billing to cover the cost, then the vaccine becomes an inescapeable loss to the doctor. The rational position to the doctor is not to sell vaccines but to prescribe them and to have the purchase of the vaccine occur outside of his practice activity.
the idea of health insurance being just for unexpected expenses went out the window a long time ago. I agree that’s ridiculous, but that’s the way it is now, and “insurance” is now universally expected to cover maintenance expenses (even if it doesn’t – e.g. medicare & preventive visits).
Insurers even market their products as such (e.g. HIP’s medicare plans with the old lady jumping through a burning zero on a motorcycle). Perhaps calling it health “coverage” is more accurate than “insurance” but that’s just semantics.
If left to consumers, however, most people do not understand the value to themselves & the public health of vaccines, and will spend $100 on the latest camera-phone before paying out-of-pocket for gardasil for their 15-yr-old.
Vaccinations are a public health benefit, and everyone will suffer as more and more choose not to vaccinate themselves & their children:
http://online.wsj.com/article/SB116925887913182362.html?mod=Letters
Sorry, Happyman
“Vaccinations are a public health benefit”. Not always.
Gardasil vaccination is indicated for cervical cancer prevention of certain types. That’s a sexually transmitted disease. The only people to benefit from that product are the heterosexually-active girl and her multiple partners.
Does that mean that ALL girls – from age 9 thru 15 (and above) should be vaccinated?
And, Gardasil costs more like $350 for the series of 3 injections.
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