Financing Vaccines in the 21st Century Assuring Access and Availability (2004) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-20
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Government purchases now account for more than half of the vaccine market. Government vaccine expenditures are "rowing rapidly;fundingfor the Vaccinesfor Children entitlement program jumpedfrom $500 million to $1 billion between 2000 and 2002 with the addition of new vaccine products to the recommended childhood schedule.
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The committee's principal recommendation is the replacement of existing government vaccine purchasing programs with a new vaccine insurance mandate, subsidy, and voucher plan. The mandate would require that all public and private insurance plans include vaccine benefits.
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Vaccines create a "herd immunity" that protects those who do not receive the vaccine because of medical conditions, those who may be too young to receive the vaccine, those who are not vaccinated because of parental indifference or religious or philosophical objections to vaccination, and those who face financial or other barriers to immunization services. By interrupting the spread of communicable disease, vaccines reduce the number of persons who become infected, diminish the burden of disease, reduce public and private health care expenditures, and improve the quality of life of the general population.
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Continued cost increases can be expected as a result of the array of new vaccines now in development. Health officials in both the public and private health care sectors are concerned about the growing fragmentation of effort within the immunization system, as well as the increasing number of recommended vaccines and the high prices of new vaccines.
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The problem of vaccine shortages has raised concerns about the relationships among the size of the government vaccine market, low vaccine prices, and the scale of investment in the production of current vaccines and the development of new vaccine products. The ability of the government to negotiate low prices for recommended vaccines is important to public health agencies and others that are trying to stretch
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These reforms may provide temporary relief from acute problems, but the nation still lacks a comprehensive finance strategy that can adapt to expected increases in both the number and prices of vaccines, continue to assure access for disadvantaged populations, and also sustain incentives for private investment in the production and licensing of current and future vaccine products. CONCLUSIONS Routine immunization for recommended vaccines, especially for children, is achieved through a partnership between public health clinics and private clinicians.
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Higher vaccine prices can be expected to exacerbate such problems as uneven distribution patterns, delays in the vaccine price negotiation processes for federal and state contracts, and continued fragmentation in the scope of vaccine benefits included in public and private health plans. An increased burden on public health clinics also occurs when private health plans reduce reimbursements for recommended vaccines in the face of higher costs.
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Increases in the budgets of government vaccine programs should be seen as acceptable, indeed desirable, insofar as new vaccines can offer substantial public health benefits. What is missing in the array of current vaccine purchasing programs is a clear and deliberate strategy that the government can use to stabilize and assure adequate rates of return on future private investments in vaccine development.
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These administrative barriers can result in missed opportunities for immunization and frequent referrals of underinsured patients to public health clinics for routine vaccines, which in turn contribute to shortfalls in immunization rates. Conclusion 4: Current government strategies for purchasing and assuring access to recommended vaccines have not addressed the relationships between the financing of vaccine purchases and the stability of the U.S.
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6. Create an insurance mandate that would require public and private health plans to cover all recommended vaccines.
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. The proposed plan, referred to as the vaccine payment system, consists of five core components that should be considered an integrated strategy for achieving the key objectives of access to and availability of vaccines: · Federal legislation would be required to establish a vaccination coverage mandate for all public and private health plans.
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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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· Support the rapid uptake of new recommended vaccines and reduce the disparities and fragmentation now associated with the time delays involved in negotiating contracts and budgets for federal vaccine purchases. · Sustain the partnership among governments (federal, state, and local)
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· Implementation of the vaccine payment plan would require substantial amendments to the laws and regulations governing various public and private health plans (e.g., ERISA, the Public Health Act, Medicare, Medicaid, and SCHIP)
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Future vaccines should receive primary consideration to stimulate the development of new vaccine products. Current ACIPrecommended vaccine components, such as tetanus, could be "grandfathered" into the mandate and subsidy category to avoid confusion and disruptions to the current vaccine schedule and immunization system.
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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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The calculation of a subsidy for current vaccines would require consideration of both the societal value of the vaccine product and recent market prices. Some vaccines might receive a subsidy significantly higher than current prices if judged to be undervalued in terms of their societal benefit.
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While many current vaccines are inexpensive, significant price increases can be expected in the future. Cost sharing could encourage consumers to shop for efficient providers and help control inflationary pressures; however, it could adversely affect immunization rates should financial factors become burdensome for the consumer.
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These programs have a history of strong bipartisan support and effective delivery of vaccines for disadvantaged populations, especially during difficult fiscal times; but they are also associated with disruptions in supply and a decrease in the number of vaccine manufacturers. Similarly, state-supported vaccine purchase programs are often the foundation of safety net immunization efforts in certain jurisdictions.
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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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