Practice-Level Vaccine Purchase Costs and Payer Reimbursement

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to understand the variability of practices' costs and reimbursement for vaccine purchase.

Background:
With the addition of expensive new vaccines to the primary immunization schedule, the private-sector cost of immunization has increased substantially over the past few years. Anecdotal evidence suggests that third-party reimbursement for vaccine is inadequate to cover the costs of vaccine purchase.

Objectives:
To document the actual purchase costs and reimbursement for vaccine for recommended childhood immunizations, from a sample of private practices.

Methods:
We selected 5 states, and targeted recruitment to small, medium, and large practices in both urban and non-urban areas. Each participating practice received provided data on cost and number of doses for the most recent purchase of each childhood vaccine, as well as specific reimbursement amount for each vaccine from the practice's three most common private third-party payers.

Results:
For many vaccines, the cost per dose varied significantly; in some instances, certain practices paid twice as much per dose as other practices. Cost per dose for the most recently recommended vaccines (HPV, MCV4) was less variable. Although the average reimbursement per dose was higher than the average cost per dose for all vaccines, the average "net yield" varied substantially. Moreover, some practices did report reimbursement lower than the purchase price for some payers. Purchasing cooperatives, rebates, and multi-product discounts affected the purchase price.

Conclusions:
Private-sector purchase prices and reimbursement are highly variable across practices. Further efforts may be needed to assist practices in lowering their purchase costs and/or negotiating for higher reimbursement.