Some parents have difficulties gaining access to insurance coverage for HPV vaccine Gardasil

Sep 1 2006

Some parents seeking to vaccinate their daughters with Merck's human papillomavirus vaccine Gardasil have experienced difficulty in obtaining it or getting it covered by health insurance, the AP/Seattle Post-Intelligencer reports (Tanner, AP/Seattle Post-Intelligencer, 8/29).

FDA last month approved Gardasil for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices later that month voted unanimously to recommend that all girls ages 11 and 12 receive the vaccine.

ACIP also recommended that Gardasil be covered by the Vaccines for Children Program, which provides no-cost immunizations to children covered by Medicaid, Alaska-native and American Indian children, and some uninsured and underinsured children (Kaiser Daily Women's Health Policy Report, 8/21).

According to Merck, the vaccine -- which is given in three injections over six months and costs $360 -- in clinical trials has been shown to be 100% effective in preventing HPV infection with strains 16 and 18, which together cause about 70% of cervical cancer cases, in women who do not already have the virus, and about 99% effective in preventing HPV strains 6 and 11, which together with strains 16 and 18 cause about 90% of genital wart cases.

Gardasil also protects against vaginal and vulvar cancers, two other gynecological cancers that are linked to HPV, according to a study presented in June at a meeting of the American Society of Clinical Oncology in Atlanta (Kaiser Daily Women's Health Policy Report, 7/31).

Health insurers Aetna, Cigna and WellPoint have said they will offer coverage for Gardasil, according to the Post-Intelligencer.

Coverage, Access

Some insurers are waiting until CDC adopts ACIP's recommendations, a step that is expected to occur in November, before agreeing to cover the vaccine, Mohit Ghose, spokesperson for the insurance trade group, America's Health Insurance Plans, said, adding that it could be months before physicians and insurers work out coverage contracts. Donald Brown, a Chicago-based pediatrician, said he is offering the vaccine and billing insurers without knowing whether it will be covered.

"This is a big school season, kids are coming in to get high school physicals and college physicals, and if we don't catch them now we'll have to wait a year," Brown said.

However, pediatrician Aleta Clark said she has not yet ordered Gardasil and recommends that people seeking the vaccine return in January 2007, by which time she thinks most insurers will cover it.

In addition, some physicians and clinics are waiting to supply the vaccine until the American Academy of Pediatrics releases its recommendations on it, according to the Post-Intelligencer.

Some physicians and clinics also are waiting to supply Gardasil until the vaccine is provided to insured children through VFC, the Post-Intelligencer reports.

Merck spokesperson Kelley Dougherty said Gardasil is available in every state but would not say how much has been ordered or shipped to physicians (AP/Seattle Post-Intelligencer, 8/29).