Hospitals would have one less cost to worry about if Congress adopts recommendations on vaccine coverage made by the Institute of Medicine.
An IOM panel last week issued a report proposing that the federal government require health insurers-both public and private-to provide vaccine benefits as part of a plan to expand the availability of immunizations.
The IOM's suggested approach "would effectively change the government's role from buying vaccines to assuring immunization," said an IOM statement issued in connection with the report. The health plan community expressed support for ideas raised by the IOM but suggested that other policy approaches also should be considered.
Requested by the Centers for Disease Control and Prevention, the IOM report follows up on a 2000 report, Calling the Shots, that said investment in vaccine development has been insufficient.
As a major purchaser of vaccines, the federal government-which currently buys about 56% of vaccines for children at a cost of more than $1 billion annually-may be stifling the innovation and competition necessary to produce the next generation of vaccines, the IOM panel said.
"The surprising thing for me is this need to assure a healthy vaccine market, which means prices can't be squashed by a single purchaser," said Eric France, chief of preventive medicine at Kaiser Permanente-Colorado and one of 11 members on the IOM's vaccine research panel, which started its work 18 months ago.
Under the panel's recommendations, the federal government would subsidize rather than buy vaccines, reimbursing health plans and providers-including hospitals-for the money they spend on immunizations.
"If it's appropriate to give a vaccine in a hospital, the hospital would not have to worry about where the financing would come from to pay for it," France said.
A new group that might operate under the CDC's Advisory Committee on Immunization Practices would evaluate the societal value of each new vaccine and help to determine an appropriate price, France said.
The health plan community agrees with the goals set forth by the IOM for increasing vaccination rates but doesn't like the idea of a new "mandate" on its members. Congress needs to "evaluate whether this is the best route," said Karen Ignagni, president of the American Association of Health Plans in Washington.
Before the federal government imposes a mandate for payment of vaccines, Ignagni said, lawmakers should also consider whether direct subsidies to manufacturers make more sense than the "roundabout approach" of subsidizing those who administer and pay for them.
Thirty years ago, more than 25 companies produced vaccines and only five do today, according to the IOM, which argued that more competition should be encouraged so that pharmaceutical companies have incentives to continue researching new vaccines.
Already debating a $400 billion Medicare prescription drug and program reform bill, lawmakers may not be ready to act right away to implement the IOM's proposal.
Over the next few years, Congress should consider the IOM's most recent recommendations but is not likely to take major action in the short term, said Adam Bozzi, a spokesman for Sen. Jack Reed (D-R.I.). "Not in September (when Congress returns from August recess) but over the next few years, this is something Congress should take a hard look at."