Family medicine physicians receive lowest HPV vaccine cost reimbursements compared to pediatricians, internal medicine doctors, nurse practitioners and other specialists

(Press-News.org) Human papillomavirus (HPV) vaccination coverage has improved in the United States, but privately insured adolescents have lower initiation and completion rates compared to those under public insurance programs. One of the contributing factors to this disparity is the higher cost of the HPV vaccine compared to other routinely recommended adolescent vaccines. While private payers typically reimburse the cost of the HPV vaccine at or above the CDC list price (i.e., $210.99 in 2017-2018), it remains below the American Academy of Pediatrics' recommended price (i.e., $263.74). Adequate reimbursement for vaccine costs by third-party payers plays a critical role in enabling doctors and other medical staff to offer and continue providing vaccines.

Researchers investigated the reimbursement rates for HPV vaccine costs across various medical specialties, including pediatricians (as the comparison group), family physicians, internal medicine specialists, nurse practitioners, and other medical practitioners. Additionally, they examined whether the reimbursement amounts were associated with the number of HPV vaccine doses administered by these health care practitioners.

The study analyzed data from over 34,000 unique practitioners and found that family physicians had the lowest net returns per dose ($0.34), while pediatricians had the highest returns ($5.08). On average, during 2017-2018, pediatricians received higher reimbursement for HPV vaccine costs ($216.07) compared to family physicians ($211.33; p<0.0001), internists ($212.97;  p<0.0001), nurse practitioners ($212.91; p<0.0001), and 'other' practitioners ($213.29;  p<0.0001). The researchers also observed that a one-dollar increase in return was associated with a slight increase in HPV vaccine doses administered, particularly among family physicians (0.08% per dollar). Although reimbursement for HPV vaccine costs by private payers is considered adequate, according to the authors, the study highlights that non-pediatric specialties have a very marginal return on investment, which may be insufficient for covering indirect expenses for stocking vaccines (storage cost, personnel cost for monitoring inventory, insurance, waste, and lost opportunity costs). The authors argue that this makes them more sensitive to changes in cost reimbursement, emphasizing the need for an increase in reimbursement rates for these practitioners so that they can continue offering the cancer-preventing HPV vaccine.

What We Know: The human papillomavirus (HPV) vaccine is the most expensive of all routinely recommended pediatric vaccines. Adequate cost reimbursement by third-party payers is important for helping practitioners continue to offer the vaccine.

What This Study Adds: Researchers determined that net returns from HPV vaccine cost reimbursements are lowest for family physicians ($0.34/dose) and highest for pediatricians ($5.08/dose). Furthermore, a one dollar increment in return was associated with an increase in HPV vaccine doses administered (highest for family physicians; 0.08% per dollar). Although reimbursement for HPV vaccine costs by private payers is generally adequate, according to the authors, non-pediatric specialties face very marginal returns on investment. The authors argue that specialties with narrow returns are highly sensitive to changes in cost reimbursement, and therefore, are worthy of increased reimbursement.

Reimbursement for HPV Vaccine Cost in the Private Sector: A Comparison Across Specialties

Kalyani Sonawane, PhD, et al
Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
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