Financing Vaccines in the 21st Century Assuring Access and Availability (2004) / Chapter Skim
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7 Recommendations
7 Recommendations
Pages 183-210
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From page 183... ...
To achieve high immunization rates, for example, government agencies frequently strive to reduce financial barriers that inhibit the demand for or administration of vaccines. This goal has led to a pricing policy that seeks to limit public expenditures, in some cases through forceful negotiation of public prices for new vaccine products and through administrative and legislative price caps on certain older vaccines (Miller, 2002~.
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From page 184... ...
Even the VFC entitlement, which has been credited with achieving substantial gains in immunization rates, is now struggling with budgetary and contracting delays and eligibility requirements that interfere with its ability to provide a reliable and sustainable safety net for a growing number of new and expensive vaccine products. Mandating coverage for vaccines within all insurance plans without providing some mechanism for insurers, employers, and individuals to recover escalating costs could lead to high numbers of uninsured persons; it could also lead some individuals either to pay higher fees (in the form of premiums or deductibles)
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From page 185... ...
assuring the availability of future vaccines by encouraging private investment in the continued production of current vaccines, as well as the development of new vaccine products. In addition, the committee sought to design a strategy that would maintain a reasonable budget for vaccine purchases for children and adults in the public and private health sectors.
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From page 186... ...
Major Features. A government-funded insurance mandate for immunization represents a reformulation of a universal vaccine purchase program and would assure that clinically appropriate immunization services would become a basic and required feature of all public and private health insurance plans.
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From page 187... ...
The committee recommends that the government replace existing vaccine purchase programs with an insurance mandate funded by a new federal finance plan that includes a subsidy, reimbursement, and voucher arrangement. The subsidy amount for each vaccine in the program would be derived from a calculation of the societal benefit of the vaccine.
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From page 189... ...
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From page 190... ...
The subsidy would shift discussion away from the costs of production (which are not known) and price, and focus attention on the societal benefits of selected vaccine products.
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From page 191... ...
· Vaccines traditionally have been recognized as having substantial spillover effects since immunization protects not just the individual, but also others in society, from contagious diseases. This is not equally true of all vaccines, however.
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From page 193... ...
This approach would also reduce missed opportunities and referrals and encourage greater participation by physicians in the national immunization system. The eligibility determination component could be tied to existing programs, such as Medicaid, to reduce the administrative burden.
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From page 194... ...
· Build upon the strengths of the current arrangements of public and private health plans and avoid the creation of separate or parallel programs. The proposed finance plan offers an opportunity to improve national immunization rates over those achieved during the past decade.
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From page 195... ...
It should also reduce the administrative burden associated with ordering and maintaining different stockpiles of vaccine products on the basis of vaccine eligibility requirements. · Support the rapid uptake of new recommended vaccines and reduce the disparities and fragmentation now associated with time delays involved in negotiating contracts and budgets for federal vaccine purchases.
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From page 196... ...
Increases in expenditures would be limited by two considerations: (1) the insurance mandate and subsidy would apply only to certain vaccinesthose that have significant spillover effects because they prevent highly contagious diseases, and (2)
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From page 197... ...
40ne committee member argued that setting a subsidy in advance on the basis of calculated societal benefit could be unnecessary and excessively difficult and could result in unnecessarily high prices. 5The technical difficulties associated with calculating societal benefits and with achieving political agreement on critical value assumptions, such as the monetary value of a life-year, are explored by the Panel on Cost-Effectiveness in Health and Medicine (Gold et al., 1996~.
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From page 198... ...
While particular stakeholder groups (the vaccine industry, health insurers, or physicians) might support or oppose certain components of the proposed strategy, a broadbased approach would need to be crafted that could achieve common goals, avoid special interests, and help define the basic incentives that should guide federal policy for vaccine finance.
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From page 199... ...
However, both are major sources of thirdparty financing for basic medical care, and both furnish immunizations. With regard to ACIP membership, voting membership should be expanded to include expertise in health insurance benefit design, public and private health care delivery systems, consumer issues (including concerns regarding vulnerable populations such as disabled persons, racial and ethnic minorities, and rural populations)
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From page 200... ...
The mandate would apply principally to vaccines with substantial spillover effects. However, other vaccines, such as therapeutic vaccines, would be considered for inclusion in cases of exceptional societal benefit, particularly when disparities in immunization rates between insured and uninsured persons persisted for a substantial time after licensure of the vaccine.
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From page 201... ...
But health plans would not be required to include the vaccine in their benefits package, and a government subsidy would not be available to reimburse the cost of the vaccine to health care providers. A vaccine might also receive a restricted recommendation to the mandate and subsidy program, for example, limiting a high-priced or less cost-effective vaccine to selected high-risk populations (block D)
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From page 203... ...
that the government would agree to provide as described in recommendation 1. Recommendation 3: As part of the implementation of recommendations 1 and 2, the National Vaccine Program Office should convene a series of stakeholder deliberations on the administrative, technical, and legislative issues associated with a shift from vaccine purchase to a vaccine mandate, subsidy, and voucher finance strategy.
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From page 204... ...
A second goal, which supports the proposal for universal coverage of all children and adults, is to reduce the current fragmentation in vaccine coverage that leads to gaps and administrative burdens in determining eligibility and to foster efficiency in providing access to vaccines that are delivered primarily in private health care settings. The means by which vaccines would be delivered to and reimbursed for different groups might differ by age, employment circumstances, and access to health care services.
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From page 205... ...
For most public programs, current program funding for vaccine purchases and vaccine administration would be replaced by the vaccine payment system dollars. For example, vaccines administered through Medicaid and SCHIP would no longer be funded through those programs' federal-state matching funds but through the new centralized vaccine system.
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From page 206... ...
To establish vaccine subsidy amounts in a consistent manner, it is essential that a standard methodology for measuring costs and benefits be established and followed. Currently, every CEA or CBA study incorporates assumptions, either implicitly or explicitly, regarding each of these issues.
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From page 207... ...
Who would administer the subsidy and voucher system? The vaccine payment system is designed to serve multiple objectives: to address the vaccine needs of vulnerable populations, to assure a reliable supply of current and future vaccines by diversifying the vaccine purchasing market, and to relieve clinicians of the administrative burden of determining individual eligibility for vaccines.
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From page 208... ...
Similarly, state-supported vaccine purchase programs are often the foundation for safety net immunization efforts in certain jurisdictions. Strategies need to be developed to assure that the payment system advocated here will at least sustain, and ideally improve, current immunization rates among disadvantaged populations.
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From page 209... ...
Research Agenda. CDC should develop an ongoing research program to examine interactions among vaccine finance strategies, immunization rates in the public and private health sectors, and the pace of innovation in the vaccine industry.
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From page 210... ...
Assuring access and sustaining incentives that contribute to the availability of safe and effective vaccines are the twin goals that must guide vaccine finance strategies in the 21st century.
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