Reimbursements for even routine vaccines like the MMR are hurting the vaccination coverage for children:
Pediatricians spend tens of thousands of dollars and must frequently wait months before payment by payers (including Medicaid and private health plans). Often payments are below the cost of the vaccine. Gardasil, the new cervical cancer vaccine, costs physicians $360 for the recommended series of three doses per person. RotaTeq, the vaccine against diarrhea-causing rotavirus, costs $190 for the recommended three doses. Even the routine measles, mumps and rubella (MMR) vaccine costs $86 for the recommended two doses. In addition to the cost of the vaccine, additional costs of ordering, storing, inventory control, insurance and spoilage expenses need to be considered. However, payers are not recognizing these true costs. As a result, some pediatricians are unable to offer the newest vaccines.
About 85 percent of children in the U.S. are vaccinated at pediatricians’ offices. Because the current system threatens to greatly reduce or even eliminate the physician provider role, the AAP is concerned that this will fragment care causing many children not to get the comprehensive and preventive health care they need.