Health Insurance Plans and Vaccine Financing in the US – Surveys Results from 2005 and 2007

Background:
Many stakeholders have expressed concern about whether the vaccine delivery system is facing financial barriers. In July 2007, NVPO worked with America's Health Insurance Plans to survey the industrys' immunization practices.

Objectives:
To determine the role of the private health insurance industry in ensuring that Americans receive appropriate ACIP-recommended vaccines without financial barriers.

Methods:
A sample of 15 health insurance companies was surveyed using an online tool in July 2007, asking their Medical or Quality Improvement staff to respond based on their best selling products. This convenience sample was selected to represent five categories: large national plans, large state plans; large regional-based plans; large PPO plans; and state Medicaid plans. Follow-up telephone interviews were conducted with 10 survey respondents in August 2007. Results from the survey and interviews were compared to a 2005 AHIP survey of 61 insurance plans. Both surveys measured the scope and determinants of health insurance plan coverage for ACIP-recommended vaccines in children and adolescents up to 18 years old, how health insurance plans establish vaccine reimbursement, and their perspectives on potential financial barriers to patients receiving appropriate vaccines.

Results:
The 2007 survey yielded findings consistent with AHIP's 2005 survey. All health insurance plans cover all ACIP recommended vaccines for children and adolescents in at least 80% of their product lines. FDA approval and ACIP recommendations were the leading conditions for coverage. Reimbursement levels were influenced by many factors, including vaccine price and physician feedback. Delays in provider reimbursement were most commonly due to claim errors or patient ineligibility.

Conclusions:
These surveys provided a broad overview of immunization coverage practices and reimbursement policies of some health insurance companies. Widespread health insurance plan coverage of vaccines underscores the value the industry places on preventive care. Variation in coverage reflects demand from employers for appropriate care that provides maximum value.