PEDIATRICS Vol. 122 No. 6 December 2008, pp. 1325-1331 (doi:10.1542/peds.2008-2038)
ARTICLE |
Variation in Provider Vaccine Purchase Prices and Payer Reimbursement
a Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan
b Child Health Evaluation and Research Unit
c Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
OBJECTIVE. The purpose of this work was to collect data regarding vaccine prices and reimbursements in private practices. Amid reports of physicians losing money on vaccines, there are limited supporting data to show how much private practices are paying for vaccines and how much they are being reimbursed by third-party payers.
METHODS. We conducted a cross-sectional survey of a convenience sample of private practices in 5 states (California, Georgia, Michigan, New York, and Texas) that purchase vaccines for administration to privately insured children/adolescents. Main outcome measures included prices paid to purchase vaccines recommended for children and adolescents and reimbursement from the 3 most common, non-Medicaid payers for vaccine purchase and administration.
RESULTS. Detailed price and reimbursement data were provided by 76 practices. There was a considerable difference between the maximum and minimum prices paid by practices, ranging from $4 to more than $30 for specific vaccines. There was also significant variation in insurance reimbursement for vaccine purchase, with maximum and minimum reimbursements for a single vaccine differing from $8 to more than $80. Mean net yield per dose (reimbursement for vaccine purchase minus price paid per dose) varied across vaccines from a low of approximately $3 to more than $24. Reimbursement for the first dose of vaccine administered ranged from $0 to more than $26, with a mean of $16.62.
CONCLUSIONS. There is a wide range of prices paid by practices for the same vaccine product and in the reimbursement for vaccines and administration fees by payers. This variation highlights the need for individual practices to understand their own costs and reimbursements and to seek opportunities to reduce costs and increase reimbursements.
Key Words: finance • payments • private practice • vaccine • private insurers
Abbreviations: ASP—average sales price • AWP—average wholesale price • CDC—Centers for Disease Control and Prevention • MSA—metropolitan statistical area
Accepted Sep 19, 2008.
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