Financing Vaccines in the 21st Century: Assuring Access and Availability

1
Financing Vaccines in the 21st Century
Assuring Access and Availability Institute of
Medicine National Academy of Sciences August
2003 American Academy of Pediatrics June 2004

Alan Kohrt, MD, FAAP
2
AAP Principles

• Access
• Quality
• Reimbursement

3
US Immunization Challenges

• Macro System LevelNational
• Access
• Financial barriers-Fragmented public-private
  financing
• Fragility of vaccine supply
• Declining incentives for manufacturers
• Micro System LevelPractice
• Quality
• Increasing numbers of recommended vaccines
• Increasing complexity of immunization schedule
• Macro/Micro System Level
• Reimbursement
• All costs
• New vaccines

4
IOM Report

• Shortages
• Variation in coverage levels
• Disparities in access

5
IOM Recommendations

• New federal subsidy to cover vaccine cost and
  administration fee based on Societal Value of a
  vaccine
• Develop a process to calculate the level of
  subsidy based on Societal Value of each vaccine
  while vaccine in development
• Mandate vaccine coverage For all plans,
  public and private Medicaid, Medicare, SCHIP,
  ERISA
• Voucher system for the uninsured

Adapted from Financing Vaccines, IOM 2003
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AAP Believes

• Immunizations are a public good
• Funded by the Federal Government
• All adults and children are immunized
• All immunizations are with highest quality
• Vaccines administrative/purchase costs reimbursed
  fairly
• Manufacturers payment sufficient to fund research
  and development
• AAP agrees with IOM recommendation for increased
  federal funding

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IOM RECOMMENDS

• Insurance mandate for all recommended vaccines
• AAP policy and discussion papers agree with
  insurance mandate
• AAP agrees with recommendation

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Concerns for Children and Families

• VFC Program
• Improved system
• Continue VFC?
• Opening legislative processrisk?
• Voucher system
• Cost, complexity
• Limit access
• Societal benefits
• Change over time
• Adult vaccine crowd out

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Concerns for Primary Care Practice

• Quality
• VFC AFIX program quality assurance
• Federal, state, practice level
• Administrative work
• Simplicity
• Reimbursement
• All costs associated with vaccines
• Fair reimbursement, incentive
• New vaccines
• Liability

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Concerns for Public Health System

• Tenuous infrastructure of PH system

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General Concerns

• Scientific questions
• Political Feasibility
• Government control/management