If we don’t pay now to vaccinate our children, they will pay later


The HPV vaccine saves lives. It does so by reducing a person’s chance of being infected by the human papilloma virus, a virus that causes a whole range of cancers including, most importantly, cervical cancer.  Vaccinate your teenage daughter against HPV, and you will increase the chance she will live to old age. Simple as that.

Yet currently, the majority of American teenagers, boys and girls, are reaching adulthood without the full protection of the vaccine. Sometimes they don’t get vaccinated because they or their parents are opposed to the vaccine (for reasons that irk me too much to dwell upon right now). To increase vaccination rates, we need to overcome people’s resistance to this vaccine.

But there’s something else that’s preventing kids from getting vaccinated that might even be more maddening than anti-vaxxers; insurance companies aren’t covering the full cost of the vaccine, causing some physicians too, shall we say, less than aggressively promote the intervention. To increase vaccination rates among American children, insurance companies need to reimburse providers more generously for vaccinating their patients.

The HPV vaccine is expensive. According to the CDC, the three doses needed for complete vaccination cost almost $500. That’s a serious chunk of change. And unlike other vaccines, when providers purchase the HPV vaccine to give to their patients, they have to use their funds, only getting reimbursed after they’ve administered it to patients (and billed insurance for the cost, and waited for their insurance payment to arrive, etc.).

That’s expensive for primary care providers, family medicine physicians, and pediatricians, who don’t make a heck of a lot of money, to begin with. Their practices purchase the vaccine and then wait to get reimbursed. Sometimes the vaccine goes bad in the meanwhile, and they have to swallow that expense.

That’s why it is important to pay providers well enough for the vaccine, to at least cover the costs of purchasing, storing, and administering it. Sadly, that’s not always the case. As a result, some providers are less than enthusiastic about urging their patients to undergo the vaccine.

According to a study out of the CDC, there is sizable geographic variation in how well providers are reimbursed for vaccine administration. The most generous state is Pennsylvania, where private insurers pay an average of $194 to physician practices for administering the vaccine, and thus almost $600 for all three. The next most generous state is Nebraska: Go Cornhuskers! But in last place stands the Terrapin state, Maryland, where providers can expect to receive an average of only $150, with neighboring Washington, D.C. not far behind (ahead?) at a rate of only $154.

What is the result of this stinginess? Areas with lower vaccine reimbursement rates also have lower vaccination rates. According to the CDC team, a $1 decrease in reimbursement for the vaccine is associated with 25,000 fewer adolescents getting at least two doses of the vaccine.

The federal government should make sure private insurers reimburse primary care physicians generously enough for HPV vaccines to cover the cost of providing those important treatments. If we don’t pay now to vaccinate our children, they will pay later.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel. He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes.

Image credit: Shutterstock.com


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