Vaccine Financing from the National Immunization Programs Perspective

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Vaccine Financing from the National Immunization
Programs Perspective

• Stephen L. Cochi MD, MPH
• Acting Director, National Immunization Program
• Centers for Disease Control and Prevention
• June, 2004

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Rationale for Requesting IOM Vaccine Financing
Study

• Address changes in vaccine financing
• Introduction of new expensive vaccines, e.g.,
  pneumococcal conjugate vaccine
• Limitations in federal discretionary funding
• Variations in insurance coverage ? 2-tiered
  system

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New Vaccine Paradigm

• Issue not vaccine efficacy or safety
• Concerns cost and implementation
• Most common childhood diseases controlled with
  existing vaccines
• Remaining diseases
• Low incidence
• High impact
• High cost to prevent

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Vaccine Financing Challenges

• Identifying the appropriate balance of federal,
  state and private insurance funding for vaccines
  to meet the needs of consumers and providers
• Assuring sufficient public sector funding
• Assuring the continued quality assurance roles of
  public health

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Consumer Needs

• Access to all recommended vaccines for all
  ages, regardless of insurance status
• In the medical home
• With little or no financial barriers to
  vaccination
• No/low copayment fees (1st dollar coverage)

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Provider Needs

• Ability to provide all recommended vaccines to
  patients of all ages, regardless of their
  insurance status
• Adequate payment for vaccine purchase and
  administration
• Consider replacement system for vaccine
  purchase??
• Mechanisms to expedite reimbursement for newly
  recommended vaccines

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Childhood Vaccine Doses Distributed by Funding
SourceCalendar Year 2003
Source Biologics Surveillance Data 2003
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Federal Contract Vaccine Prices For Vaccines
Recommended Universally for Children, 1985 2004
472
114
45
Federal contract price shown for one year is an
average that accounts for price changes within
the year. An estimate is provided for 2004
since contract prices may change in August 2004
April 14, 2004
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Percent Increase of the Cost of Full Series vs.
Percent Increase of Appropriation
Percentage Calculations increases are
cumulative using 1999 as the base year.
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Pneumococcal Conjugate Vaccine (PCV) Two-Tier
Policies, by State, United States
D.C.
As of February 2003
States with a two-tiered PCV policy (19 states
are not implementing PCV with 317 funds)States
without a two-tiered PCV policy
If all States implemented PCV and flu, the 2004
funding shortfall would be 55 Million
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New Vaccines to 2020
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Concerns if Vaccine Financing Remains an Issue

• Introduction of new vaccines (or recommendations)
  will continue two-tier trend
• Pressure to introduce new vaccines may force
  programs to provide existing vaccines through
  two-tiered systems
• Variable implementation of recommendations will
  result in variable coverage levels and increased
  possibility of outbreaks

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Six Roles of the Nations Immunization Program
Assure Vaccine Purchase
AssureServiceDelivery
Control and PreventInfectiousDisease
Surveillanceof Vaccine Coverageand Safety
Sustain and ImproveCoverage Rates
Immunization FinancePolicies and Practices
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Public Sector Vaccine Cost to Fully Vaccinate a
Child
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Number of Children Who Could Potentially Receive
Full Series with Section 317 Funds
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Key Benefits of IOM Recommendations

• Increases value of vaccines
• Makes vaccines available as a near universal
  entitlement
• Provides economic incentives for providers and
  manufacturers
• Potential to reduce administrative burden on
  private providers
• Allows vaccine recommendations to be made by
  experts without interference from standard
  political and budget processes

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Key Disadvantages of IOM Recommendations

• Possibility of unintended consequences from
  theoretically-based, untested system
• Reduces public health quality assurance role
• Does not assure vaccine uptake
• May erode public/private partnership established
  through public supply of vaccines
• Federal budget will be greatly increased