are enrolled in non-HMO health plans that require deductibles to be met before plan coverage and require out-of-pocket expenditures for services.

Recommendation 4-5. Private and public insurance coverage for hepatitis B vaccination should be expanded.

  • Public Health Section 317 should be expanded with sufficient funding to become the public safety net for underinsured and uninsured adults to receive the hepatitis B vaccination.

  • All private insurance plans should include coverage for all ACIP-recommended vaccinations. Hepatitis B vaccination should be free of any deductible so that first-dollar coverage exists for this preventive service.

Vaccine Accessibility

The hepatitis B vaccine is available at some physician offices, designated health clinics, and some community-based outreach programs. However, many health-care providers’ offices do not offer vaccination, and many US cities do not have health clinics or community-based programs that provide the hepatitis B vaccine (Rein et al., 2010). Making the vaccine available through nontraditional settings, such as pharmacies, would probably increase hepatitis B immunization rates in the United States. Previous studies have shown that use of nontraditional settings, such as pharmacies and supermarkets, to deliver vaccines to US adults results in increased accessibility and convenience, reduced cost, and increased public awareness of the need for adult immunization (Postema and Breiman, 2000). That strategy is also likely to be cost-saving (Prosser et al., 2008). The involvement of community pharmacies in vaccine distribution and administration has been growing in recent years (Westrick et al., 2009), and enlisting their participation in public delivery of the hepatitis B vaccine is a natural progression.

Vaccine-Supply Concerns

Several studies of vaccine supply in the United States have expressed concerns regarding vaccine shortages (Jacobson et al., 2006; Klein and Myers, 2006; Santoli et al., 2004). Reasons for vaccine shortages include cessation of production by manufacturers due to lack of profitability, liability issues, problems with vaccine production, and unanticipated vaccine demands (Klein and Myers, 2006; Santoli et al., 2004). From 2000 to 2004, there were shortages of six pediatric vaccines: combined tetanus–diphtheria toxoids (November 2000–June 2002), diphtheria–tetanus–acellular pertus-



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