Low reimbursement rates for HPV vaccine could be a barrier to access

Bare minimum reimbursement rates could be a factor in why some clinics may be struggling to offer HPV vaccination in the U.S.

MUSC Hollings Cancer Center researcher Kalyani Sonawane, Ph.D., and a team of researchers from South Carolina and Texas decided to quantify private insurance reimbursement rates for the HPV vaccine after several qualitative studies noted that health care providers were dissatisfied with HPV vaccine reimbursement by private insurance companies.

The results of their investigation were published July 24 in the Annals of Family Medicine.

They found that non-pediatric specialties were reimbursed at lower rates compared with pediatricians.

Although all specialties received at least the minimum payment recommended by the Centers for Disease Control and Prevention, that rate covers only the cost of the vaccine itself, Sonawane said.

Family medicine doctors received an average of 34 cents above the recommended rate, which would have to cover all of the indirect costs of vaccination, like storage, administration, insurance and record-keeping. In contrast, pediatricians received an average of $5.08 above the recommended rate.

"Family physicians – who are so critical and important, especially in rural areas where not all patients have access to pediatricians – are not receiving adequate reimbursement for the HPV vaccine, which is sort of a disincentive for them to offer this critical cancer-preventive vaccine," Sonawane said.

"We did find that the number of doses administered by each specialty was slightly sensitive to the reimbursement level or the margin that they were receiving through the reimbursements, and family physicians were most sensitive to the change in reimbursement," she added.

The HPV, or human papillomavirus, vaccine is recommended for adolescents at age 11 or 12, although it can be given starting at age 9 and up to age 45.

It protects men and women against HPV strains that can cause six types of cancer. The Healthy People 2030 goal is to have 80% of adolescents up to date on HPV vaccines by then. Right now, about 62% are up to date.

After lagging behind other states, South Carolina is now on par with national averages. Hollings has made a special effort to increase HPV vaccination rates, launching a statewide campaign in 2019 to improve them.

In 2021, Hollings launched the Community Health Van, which travels across the state offering HPV and other childhood vaccines as well as cancer education.

Sonawane suspects that the lower reimbursement rates for family physicians could contribute to geographic disparities in vaccination rates. Adolescents in rural areas are less likely to be up to date on vaccines than those in urban or suburban areas. Part of the issue is parental hesitancy about vaccines, she said. Lack of availability, though, if doctors in rural areas don't stock the vaccine, could be another barrier.

"The key message here is that, yes, we are meeting the minimum threshold that the CDC has put out there, but that may not be enough to sustain vaccination programs, particularly in family medicine clinics," she said.

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