Poor reimbursement rates for vaccines have become a problem for many family and pediatric physicians and the costs are dragging their practices down.
The development of new vaccines and the expansion of vaccination criteria prevent many physicians from covering the regular costs of some childhood vaccines.
“You can’t absorb these costs,” said Anne Francis, MD, of Elmwood Pediatric Group in Rochester, N.Y. “The new vaccine products are incredibly expensive. The costs have just exploded.”
The reason immunization costs have risen so much is that new vaccines – such as the human papillomavirus vaccine, Guardasil – are proprietary. The vaccines cost a great deal to develop, test and distribute, and medical technology companies need to get a return on their investment.
“I think physicians are going to have to become more savvy in the way they run their practices,” said Gary Freed, MD, lead author of “Primary Care Physician Perspectives on Reimbursement for Childhood Immunizations,” published in Pediatrics, the official journal of the American Academy of Pediatrics.
“I don’t expect physicians to stop practicing or administering vaccines due to the cost, especially in the short term,” Freed said.
If there were a common ground from which to negotiate drug reimbursement, such as the Centers for Disease Control price list, it would level out compensation, said Francis. Reimbursement for vaccine administration is also something that varies across payers.
“Insurance companies are in the business of paying the least they can for services,” she said. “And traditionally, they really haven’t paid for administration fees.”
Only in the past few years have administration fees been covered, Francis said. Medicaid reimburses at $9 per injection, but the average reimbursement is around $14.
Some physicians turn to services such as the Merck Vaccine Reimbursement Support Center, which have been set up to assist physicians and their staff in obtaining the information they need when a patient’s plan doesn’t reimburse adequately. Such programs educate physicians about the vaccine reimbursement process, and will sometimes help cover costs.
But Freed acknowledges that some of the blame can be placed on the poor business practices of the physicians themselves.
“Physicians must become more savvy about determining the appropriate reimbursement,” he said.