Government requires private insurance plans to fully cover recommended vaccines
As part of the Obama administration’s health-care reform efforts, private insurers will soon be required to fully cover a number of preventive health services, with no patient co-pays or deductibles permitted. Included in this list are all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). Here is coverage of the announcement from ABC News, the New York Times, and Reuters.
According to new regulations released by the Department of Health and Human Services (HHS), as of September 23 all new or revised insurance plans must include all preventive services recommended by the United States Preventive Services Task Force and the ACIP. In addition to vaccines, other covered preventive services include colonoscopies, mammograms, well-child visits, and screening for chronic conditions.
For vaccines, these regulations further add to the importance and influence of the ACIP. Already, the committee’s recommendations are routinely adopted in full by CDC. Also, it has direct authority to add newly recommended vaccines to the Vaccines for Children (VFC) program, the federal entitlement program that provides vaccines to uninsured or underinsured children. The new consequences of ACIP recommendations for private insurance plans will further emphasize the committee’s broadened mandate in recent years to evaluate the cost-effectiveness and overall health policy implications of its actions, in addition to scientific and medical assessments of the impact of proposed vaccine recommendations. Accordingly, the insurance industry is likely to be far more interested in the work of the ACIP, as it will now directly determine the vaccines that must be included in their plans.
For patients, physicians, advocates of immunization, and vaccine manufacturers, these regulations will certainly be viewed as good news. While coverage of recommended pediatric vaccines by private insurers is generally quite good, co-pays and administrative costs can present obstacles for some patients. For adult immunization, the impact of the regulations are likely to be even more significant, as coverage for recommended adult vaccines is highly variable, often only partially covering ACIP-recommended vaccines or requiring significant co-pays. Not surprisingly, adult vaccination rates have lagged far behind those of children. While financing considerations are among many obstacles impeding adult vaccination efforts, these new regulations for third-party insurance plans will certainly be seen as beneficial.
While the language regarding the regulations’ impact on HPV vaccine coverage is rather obtuse, it states that after a short grace period on account of the relatively new recommendation for Cervarix, insurers will be required to fully cover both HPV vaccines in all recommended populations (currently girls and women 9-26). It appears however, that there is no such requirement for insurance coverage of male HPV vaccination, since it lacks an ACIP recommendation.
-- Guest post by Laura Backup, Intern at Penn Center for Bioethics
According to new regulations released by the Department of Health and Human Services (HHS), as of September 23 all new or revised insurance plans must include all preventive services recommended by the United States Preventive Services Task Force and the ACIP. In addition to vaccines, other covered preventive services include colonoscopies, mammograms, well-child visits, and screening for chronic conditions.
For vaccines, these regulations further add to the importance and influence of the ACIP. Already, the committee’s recommendations are routinely adopted in full by CDC. Also, it has direct authority to add newly recommended vaccines to the Vaccines for Children (VFC) program, the federal entitlement program that provides vaccines to uninsured or underinsured children. The new consequences of ACIP recommendations for private insurance plans will further emphasize the committee’s broadened mandate in recent years to evaluate the cost-effectiveness and overall health policy implications of its actions, in addition to scientific and medical assessments of the impact of proposed vaccine recommendations. Accordingly, the insurance industry is likely to be far more interested in the work of the ACIP, as it will now directly determine the vaccines that must be included in their plans.
For patients, physicians, advocates of immunization, and vaccine manufacturers, these regulations will certainly be viewed as good news. While coverage of recommended pediatric vaccines by private insurers is generally quite good, co-pays and administrative costs can present obstacles for some patients. For adult immunization, the impact of the regulations are likely to be even more significant, as coverage for recommended adult vaccines is highly variable, often only partially covering ACIP-recommended vaccines or requiring significant co-pays. Not surprisingly, adult vaccination rates have lagged far behind those of children. While financing considerations are among many obstacles impeding adult vaccination efforts, these new regulations for third-party insurance plans will certainly be seen as beneficial.
While the language regarding the regulations’ impact on HPV vaccine coverage is rather obtuse, it states that after a short grace period on account of the relatively new recommendation for Cervarix, insurers will be required to fully cover both HPV vaccines in all recommended populations (currently girls and women 9-26). It appears however, that there is no such requirement for insurance coverage of male HPV vaccination, since it lacks an ACIP recommendation.
-- Guest post by Laura Backup, Intern at Penn Center for Bioethics
Labels: ACIP, Business of Vaccines, Cervarix, Economics, Gardasil, HPV, Policy, Recommendations, Vaccination rates
posted at 11:57 AM
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