Learning Objectives for this Presentation:
By the end of the presentation participants will be able to appreciate the influences on changes in state vaccine financing policies over the past few years.

Background:
Nationally, the Vaccines for Children (VFC) program supplies government-purchased vaccine for specific eligibility groups. States may choose to supply vaccines only to VFC-eligible children, or to adopt an expanded vaccine financing policy to cover more children.

Objectives:
To understand recent changes in state vaccine financing systems.

Methods:
We conducted structured telephone interviews with immunization program managers, medical directors, and/or other key immunization staff. Specific questions explored current and recent vaccine financing policies, funding for expanded vaccine financing, and reasons for changes.

Results:
The number of states with full universal purchase (i.e., supplying government-purchased vaccine for all children in the state) is declining. Several states have a policy of universal purchase for some vaccines, with different policies for newer vaccines such as HPV or MCV. The primary reason for changes in state vaccine financing policies pertain to the number of new vaccine recommendations, coupled with the high cost of newer vaccines and inconsistent federal 317 funding. In some instances, changes in state contributions for vaccine purchases also has influenced the state vaccine financing policy. State officials expressed concern that the VFC definition of “underinsured” has become outdated, given changing paradigms for insurance coverage of childhood vaccines; more information is needed to determine if insurance coverage is less common for newer vaccines. State immunization officials described a variety of mechanisms for prioritizing vaccine purchase when funding is limited.

Conclusions:
Changes in state vaccine financing systems appear to be increasing in frequency. Decisions about vaccine financing vary in both process and outcome. There is a need to address 317 funding levels and the definition of underinsured.