“The new HPV vaccine: What the ObGyn needs to know,” an expert panel moderated by Thomas C. Wright, MD (January 2007)
In the roundtable discussion of the new HPV vaccine, the question was raised—“who pays?” Why is it assumed that we will buy this expensive vaccine, administer it to our patients, and then hope to be reimbursed by someone—either the insurance company or the patient? We advise our patients to be vaccinated against HPV, but address the problem of reimbursement in a practical fashion. We don’t buy anything.
With other injectables and related medical items such as the levonorgestrel-releasing intrauterine system (Mirena), the amount reimbursed by some insurers is less than the true cost of the items. Because we lost money every time we administered these medications, including the HPV vaccine (Gardasil), we decided to change course. Now we write a prescription for the medication and instruct the patient to have it filled at her pharmacy. In the case of IUDs, the items are mailed directly to our office by the company. Medroxyprogesterone acetate and the HPV vaccine are dispensed to the patient, who brings the medications to our office for injection.
By refusing to buy and stock these agents, we put the financial responsibility back where it belongs: on the patient and her insurance company. If every gynecologist did as we do, these medications would be covered like any other drug we prescribe. Then we could get back to the business of delivering good medicine without taking financial risks that belong elsewhere.
Marion Pandiscio, MD
Bradenton, Fla
Dr. Wright responds: For now, focus should be on young women
I appreciate Dr. Avery’s questions about clinical applications of the new HPV vaccine, and offer the following responses:
- When considering whether to vaccinate women over age 26, one point in particular is key: The vaccine is not approved for use in this age group, and we lack safety and efficacy data for this application. I believe the vaccine will be proven safe in women over age 26, but its efficacy will probably be lower than in younger women for a couple of reasons. First, as we age, we tend to become less responsive to vaccines. Second, older women are more likely to have been exposed to the vaccine HPV types than young women are.
- In most instances, men are vectors for the transmission of HPV to women. However, infections typically are spread in a different pattern when they are transmitted sexually, as opposed to other forms of transmission. Core groups are composed of individuals who are especially active, with many sexual partners, and these groups contribute disproportionately to the spread of infection. Although HPV is not restricted to these core groups, a male vaccination program is unlikely to have a significant impact on infections in women until it achieves high coverage rates in men.
- To date no data indicate that the vaccine can be used as a treatment for women with abnormal Pap tests.
As Dr. Pandiscio points out, reimbursement for expensive vaccines and other medical items is a significant issue for most practitioners—not just ObGyns. Unfortunately, when patients obtain vaccines at a pharmacy, they often pay more for them. There are reports of pharmacies charging up to $185 per dose for Gardasil, which is more than 50% higher than the wholesale cost.