Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleResearch Briefs

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

Yenan Zhu, Yueh-Yun Lin, Ruosha Li, Cara He, David R. Lairson, Ashish A. Deshmukh and Kalyani Sonawane
The Annals of Family Medicine July 2023, 21 (4) 344-346; DOI: https://doi.org/10.1370/afm.2990
Yenan Zhu
1Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
2Medical University of South Carolina, Hollings Cancer Center, Charleston, South Carolina
MS, PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Yueh-Yun Lin
3Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
MS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ruosha Li
4Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Cara He
5Baylor College of Medicine, Baylor Universiry, Houston, Texas
BS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
David R. Lairson
3Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ashish A. Deshmukh
1Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
2Medical University of South Carolina, Hollings Cancer Center, Charleston, South Carolina
PhD, MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kalyani Sonawane
1Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
2Medical University of South Carolina, Hollings Cancer Center, Charleston, South Carolina
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: sonawane@musc.edu
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Abstract

The human papillomavirus (HPV) vaccine is the most expensive of all routinely recommended pediatric vaccines. Adequate cost reimbursement by 3rd-party payers is a critical enabling factor for clinicians to continue offering vaccines. This study found 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 $1 increment in return was associated with an increase in HPV vaccine doses administered (highest for family physicians; 0.08% per dollar). Reimbursement for HPV vaccine costs by private payers is adequate; however, return margins are small for non-pediatric specialties.

Key words:
  • primary health care
  • family medicine
  • human papillomavirus
  • vaccination
  • vaccine
  • HPV

Human papillomavirus (HPV) vaccination coverage has improved in recent years in the United States. However, initiation and completion rates are lower among privately insured adolescents (4.6%- and 2.0%-points lower, respectively, in 2021) compared with adolescents covered under public insurance programs.1 The HPV vaccine is the most expensive of all routinely recommended adolescent vaccines. Vaccine-related products are costly, therefore, adequate reimbursement for vaccine costs by 3rd-party payers is a critical enabling factor for clinicians to offer and continue providing vaccines. In the United States, the Centers for Disease Control and Prevention (CDC) vaccine list price is used as a benchmark by the private sector for vaccine cost reimbursement; however, reimbursement for vaccine cost varies.2 The objective of this study is to compare HPV vaccine cost reimbursement by the private sector across provider specialties. Additionally, we examine whether the return from reimbursement correlates with the number of HPV vaccine doses administered by clinicians.

METHODS

We identified a nationwide sample of HPV vaccine-eligible adolescents (ie, adolescents aged 9 to 14 years) enrolled in a large private health insurance plan during 2017-2018. Data from states with a universal or universal select vaccine purchase program (ie, Alaska, Hawaii, Idaho, Maine, Massachusetts, South Dakota, New Hampshire, New Mexico, Rhode Island, Vermont, Washington, Wisconsin, and Wyoming) were excluded. The specialty of the clinician (pediatrician, family physician, internal medicine specialist, nurse practitioner, and other) who administered the HPV vaccine was identified using the unique encrypted provider ID that crosswalks the clinician information file and medical claims data. We determined the number of HPV vaccine doses administered by each clinician during 2017-2018. Reimbursement for the HPV vaccine was calculated as the dollar amount paid by the insurer to clinicians to cover the cost of purchasing the vaccine. We also calculated the net return per HPV vaccine dose (ie, payer reimbursement minus the CDC list price).

Average reimbursements for HPV vaccine purchase costs were estimated for the 5 specialties and were compared (pediatricians as a reference group) using the Kruskal-Wallis test. Multivariable linear regression models were constructed to understand the sensitivity of each specialty to administering more (or fewer) HPV vaccine doses relative to return from vaccine cost reimbursement. The independent variable was the return margin per dose (ie, payer reimbursement minus the CDC list price) for each clinician and the dependent variable was the clinician’s HPV vaccine administration rate (ie, the total number of visits during which an HPV vaccine was administered divided by the total number of preventive care visits times 100). Models were adjusted for the proportion of visits by female and urban adolescents. All analyses were conducted using SAS/SQL (SAS Institute Inc). Significance was tested for P <0.05.

RESULTS

The final sample included 34,247 unique clinicians (Table 1). Overall, HPV vaccine cost reimbursement by private payers was at or above the CDC list price (ie, $210.99) but below the American Academy of Pediatrics (AAP) recommendations (ie, $263.74). On average, pediatricians received higher reimbursement ($216.07) for HPV vaccine cost compared with family physicians ($211.33; P <.001), internists ($212.97; P <.001), nurse practitioners ($212.91; P <.001), and “other” clinicians ($213.29; P <.001). The net return from vaccine cost reimbursements was lowest for family physicians ($0.34 per HPV vaccine dose administered) and highest for pediatricians ($5.08 per HPV vaccine dose administered). The predicted change in HPV vaccine administration rate per one-dollar increase in return margin was significant for family physicians (0.08% [0.06% to 0.09%]), “other” specialties (0.06% [0.002% to 0.11%]), and pediatricians (0.05% [0.04% to 0.07%]) (Table 2).

View this table:
  • View inline
  • View popup
Table 1.

HPV Vaccine Reimbursement by Private Payer Across Clinician Specialties, 2017-2018

View this table:
  • View inline
  • View popup
Table 2.

Association Between Net Return Per Dose and HPV Vaccine Doses Administered, 2017-2018

DISCUSSION

Concerns regarding HPV vaccine reimbursement are frequently reported in clinician surveys.3-5 In our study, HPV vaccine cost reimbursements were at or above the CDC list price but varied by specialty. The variation in reimbursements across specialties might be tied to the ability to negotiate reimbursements for adolescent vaccines. For instance, pediatricians may be able to negotiate higher cost reimbursement compared with non-pediatric specialties given that adolescents constitute a large fraction of their patient volume. It is noteworthy that HPV vaccine cost reimbursement to family practitioners was considerably less in our study, barely breaking even, despite the second highest volume of HPV vaccination encounters (after pediatricians). The financial and operational challenges of stocking vaccines by family physicians documented in the literature corroborate these findings.6-8

We also report that the return margin is positively correlated with the number of HPV vaccine doses administered by practitioners. For instance, changing HPV vaccine reimbursement to the AAP-recommended level ($263.74, ie, a net return of +$40), could translate to an estimated 18,643 additional HPV vaccine doses administrated by pediatricians, 4,041 additional doses by family physicians, and 433 doses by “other” specialty in 2017-2018. The change at the population level will depend upon the magnitude of the increase in vaccine cost reimbursement and the volume of adolescent visits (ie, opportunities for HPV vaccination). While it may not be possible to increase reimbursement to the AAP-recommended level, a reasonable increase that can cover direct and indirect expenses (acquisition cost, storage cost, personnel cost for monitoring inventory, insurance, waste, and lost opportunity costs) will reduce the financial strain on non-pediatric clinicians, encouraging them to stock and offer the HPV vaccine at their clinics.

Our study should be interpreted within the context of its limitations. Our models did not account for factors related to clinicians (vaccination bundling, knowledge of vaccination schedule, or recommendation style), clinic (reminder prompts in electronic medical records or overhead costs of vaccines), and/or parents of the adolescents (knowledge or vaccine hesitancy) that might contribute to variation in HPV vaccination. We used data from a single private payer which limits the generalizability of our findings.

In conclusion, HPV vaccine cost reimbursement in the private sector meets the CDC list price threshold. Specialties that have very small return margins are most secnsitive to changes in cost reimbursement. A consideration toward increasing reimbursement for HPV vaccine cost is warranted.

Footnotes

  • Conflicts of interest: A.A.D. reported receiving a consulting fee from Merck on unrelated projects. K.S. has provided consultancy to Value Analytics Labs on unrelated projects. All other authors declare no competing interests.

  • Read or post commentaries in response to this article.

  • Funding support: Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities under award number K01MD016440 and the National Cancer Institute of the National Institutes of Health under award number R01CA232888. The funders did not participate in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

  • Received for publication July 27, 2022.
  • Revision received January 27, 2023.
  • Accepted for publication February 23, 2023.
  • © 2023 Annals of Family Medicine, Inc.

REFERENCES

  1. 1.↵
    1. Pingali C,
    2. Yankey D,
    3. Elam-Evans LD, et al.
    Supplemental Table 2. Estimated vaccination coverage with selected vaccines and doses among adolescents aged 13–17* years, by Health Insurance Status—National Immunization Survey–Teen (NIS-Teen), United States, 2021. Published 2022. https://www.cdc.gov/vaccines/imz-managers/coverage/teenvaxview/pubs-presentations/NIS-teen-vac-coverage-estimates-2021-tables.html#table-02
  2. 2.↵
    1. Tsai Y,
    2. Lindley MC,
    3. Zhou F,
    4. Stokley S.
    Insurance reimbursements for human papillomavirus vaccination in the private sector, 2007-2014. Prev Med Rep. 2019;15:100917. doi:10.1016/j.pmedr.2019.100917
    OpenUrlCrossRef
  3. 3.↵
    1. Cataldi JR,
    2. O’Leary ST,
    3. Markowitz LE, et al.
    Changes in strength of recommendation and perceived barriers to human papillomavirus vaccination: longitudinal analysis of primary care physicians, 2008-2018. J Pediatrics. 2021; 234: 149-157.e3. doi:10.1016/j.jpeds.2021.03.002
    OpenUrlCrossRef
  4. 4.
    1. Walling EB,
    2. Dodd S,
    3. Bobenhouse N,
    4. Reis EC,
    5. Sterkel R,
    6. Garbutt J.
    Implementation of strategies to improve human papillomavirus vaccine coverage: a provider survey. Am J Prev Med. 2019; 56(1): 74-83. doi:10.1016/j.amepre.2018.07.038
    OpenUrlCrossRef
  5. 5.↵
    1. Lake PW,
    2. Kasting ML,
    3. Christy SM,
    4. Vadaparampil ST.
    Provider perspectives on multilevel barriers to HPV vaccination. Hum Vaccin Immunother. 2019; 15(7-8): 1784-1793. doi:10.1080/21645515.2019.1581554
    OpenUrlCrossRef
  6. 6.↵
    1. Campos-Outcalt D,
    2. Jeffcott-Pera M,
    3. Carter-Smith P,
    4. Schoof BK,
    5. Young HF.
    Vaccines provided by family physicians. Ann Fam Med. 2010; 8(6): 507-510. doi:10.1370/afm.1185
    OpenUrlAbstract/FREE Full Text
  7. 7.
    1. Allison MA,
    2. O’Leary ST,
    3. Lindley MC, et al.
    Financing of vaccine delivery in primary care practices. Acad Ped. 2017; 17(7): 770-777. doi:10.1016/j.acap.2017.06.001
    OpenUrlCrossRef
  8. 8.↵
    1. Anim TE.
    The dilution of family medicine: waning numbers of family physicians providing pediatric care. J Am Board Fam Med. 2020; 33(6): 828-829. doi:10.3122/jabfm.2020.06.200544
    OpenUrlFREE Full Text
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 21 (4)
The Annals of Family Medicine: 21 (4)
Vol. 21, Issue 4
July/August 2023
  • Table of Contents
  • Index by author
  • Front Matter (PDF)
  • Plain-Language Summaries
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Reimbursement for HPV Vaccine Cost in the Private Sector: A Comparison Across Specialties
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
6 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Reimbursement for HPV Vaccine Cost in the Private Sector: A Comparison Across Specialties
Yenan Zhu, Yueh-Yun Lin, Ruosha Li, Cara He, David R. Lairson, Ashish A. Deshmukh, Kalyani Sonawane
The Annals of Family Medicine Jul 2023, 21 (4) 344-346; DOI: 10.1370/afm.2990

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Reimbursement for HPV Vaccine Cost in the Private Sector: A Comparison Across Specialties
Yenan Zhu, Yueh-Yun Lin, Ruosha Li, Cara He, David R. Lairson, Ashish A. Deshmukh, Kalyani Sonawane
The Annals of Family Medicine Jul 2023, 21 (4) 344-346; DOI: 10.1370/afm.2990
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • METHODS
    • RESULTS
    • DISCUSSION
    • Footnotes
    • REFERENCES
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Changes in the Ambulatory Use of Antibiotics in France Due to the COVID-19 Pandemic in 2020-2022: A Nationwide Time-Series Analysis
  • Heplisav-B vs Standard Hepatitis B Vaccine Booster for Health Care Workers
  • The General Public Vastly Overestimates Primary Care Spending in the United States
Show more Research Briefs

Similar Articles

Subjects

  • Domains of illness & health:
    • Prevention
  • Methods:
    • Quantitative methods
  • Other research types:
    • Health services
    • Professional practice

Keywords

  • primary health care
  • family medicine
  • human papillomavirus
  • vaccination
  • vaccine
  • HPV

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine