Immunization Funding

1
Immunization Funding

• Arvy Smith
• Deputy State Health Officer

2
Issues

• Vaccination Costs Versus Federal Appropriations
• Costs to Vaccinate a Child
• Cost Increases
• Costs of New Vaccines
• Total Costs to Vaccinate
• The Funding Gap
• One Solution the Immunization Partnership
  Project
• General Strategies to Fill the Gap

3
Cost of Vaccines to Immunize One Child vs. Annual
Federal Vaccine Purchase Appropriations
1,137
Vaccine cost to immunize one child (511
increase)
263 M
186
Vaccine purchase appropriation (91 increase)
138M
4
Costs to Vaccinate a Child

• Year Amount
• 1999 186
• 2004 476
• 2005 618
• 2006 1,137

5
Cost Increases

• Price New
• Increases Vaccines
• 2004-2005 19.96 121.81
• (4) (25)
• 2005-2006 13.43 505.90
• (2) (80)

6
Costs of New Vaccines

• One Rec.
• Vaccine Age Group Catch-Up
• Menactra 68 570,000 4.0 M
• Rotavirus 156 1,307,000 0
• HPV 300 1,257,150 8.8 M
• Varicella 2 56.9 0 477,000 5.7 M

7
Total Costs to Vaccinate(In Millions)

• 2005 2006 2007 2008
• Actual Est. Est. Est.
• VFC 2.2 2.8 3.7 3.8
• Non VFC 2.4 4.0 6.2 6.5
• Total 4.6 6.8 9.9 10.3

8
Total Funding Gap(In Millions)

• 2005 2006 2007 2008
• Actual Est. Est. Est.
• Non VFC 2.4 4.0 6.2 6.5
• 317 Est. 2.0 1.9 1.7 .5
• Total Gap .4 2.1 4.5 6.0

9
Filling the Gap

• 2005 2006 2007 2008
• Actual Est. Est. Est.
• Total Gap .4 2.1 4.5 6.0
• State .2
• BC/BS .2 2.4 4.8 5.0
• Gap .0 (.3) (.3) 1.0
• (Surplus)

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Filling the Gap

• 2005 2006 2007 2008
• Actual Est. Est. Est.
• Total Gap .4 2.1 9.4 11.0
• State .2
• BC/BS .2 2.4 8.4 8.7
• Gap .0 (.3) 1.0 2.3
• (Surplus)

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Causes of the Funding Gap

• 317 Funding
• Insufficient to cover non VFC
• Likely to decline significantly in 2008 to
  500,000 per year
• New Vaccines
• Ten (or more) new vaccines
• Potential cost - additional 2000 per child

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New Vaccines on the Horizon

• Chlamydia
• Type of influenza that causes ear infections
• HIV
• Strep
• Another type of meningitis
• Lower respiratory infections
• RSV
• Genital Herpes in women
• Staph infections

13

• WE NEED
• A NEW IMMUNIZATION STRATEGY
• FOR NORTH DAKOTA
• NOW!

14
One SolutionThe Immunization Partnership Program

• Obtaining best price for vaccines
• DoH purchases and supplies vaccines
• Providers enter payor information into NDIIS
• BC/BS reimburses DoH for BC/BS covered children
• Entirely dependent on comprehensive, accurate,
  entering of payor into NDIIS

15
One SolutionThe Immunization Partnership Project

• BC/BS insures 42 of the children in ND.
• Invited top ten or so other insurers in the state
  to participate in the model.
• So far no positive response.
• Going statewide would require a mandate for
  insurers not only to provide full coverage for
  immunizations but to reimburse DoH for vaccines
  rather than providers may not be possible.

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General Strategies to Fill the Gap

• Maximize Resources
• Maximize use of VFC (Identify all VFC eligibles)
• Control use of 317
• Appropriately charge all payors
• Access state funding

17
General Strategies to Fill the Gap

• Contain Costs
• Obtain lowest price for vaccines
• Keep administration costs low

18
State Funding

• Current and past budgets approximately 150,000
  per year
• Typically used for flu vaccine, outbreaks, and
  STD and TB medications
• Budget request for 1.0 million per year in
  addition to our current budget
• Discovered that 1.2 million of our vaccine costs
  each year are for children covered by other
  insurance companies

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Conclusions

• Costs to vaccinate a child are increasing
  dramatically
• Federal funding is holding steady at best
• Solvency of immunization program is dependent on
  317 funding which is declining
• Need to explore all options to determine the most
  cost effective way to vaccinate all North Dakota
  children