1

ACCESSING HPV VACCINE: Preliminary Progress

Alexandra Stewart, JDDepartment of Health Policy

Contact: stewarta@gwu.edu

June 2, 2007

2

FEDERAL FUNDING: – Ensured access to vaccines through VFC and 317

– Ensured access to vaccines through Medicaid, SCHIP

PRIVATE MARKET FUNDING:– Increased access to vaccines through private health

insurance coverage

STATE STATUTES:– Increased access to vaccines through school entry

requirements

ACIP* Recommendations Trigger 3 Avenues to Access

* Advisory Committee of Immunization Practices

3

VACCINES FOR CHILDREN (VFC)• Free vaccines to age19 who are: Uninsured, underinsured, Medicaid eligible, American Indian, Alaska native

MEDICAID EARLY, PERIODIC SCREENING, DIAGNOSIS & TREATMENT(EPSDT)

STATE CHILDREN’S HEALTH INSURANCE PROGRAM (SCHIP) • Covers ACIP-recommended vaccines for children in families with incomes that

are too high for Medicaid, but have no insurance. States set age limitations for program eligibility.

SECTION 317 • Awards grants to state, local, & territorial public health agencies for program

operations and vaccine purchases. Limited funds available for vaccine purchase PUBLIC HEALTH CLINICS • Some states provide free or low-cost vaccines to the uninsured (children or adults)

Public Funding of Vaccines

4

MEDICAID COVERAGE of HPV VACCINE for AGES 21-26

AGESCOVERAGE

OBLIGATIONCOVERAGE STANDARD

FINANCING

0 through 18 Required (EPSDT)

ACIP Vaccines for Children

19 and 20 Required ACIP Designated Match

21 through 26 Optional Discretionary Designated Match

After age 21, enrollee must establish adult eligibility. Each state has different criterion based on income, parental status, disability, gender

Source: GWU/SPHHS Medicaid Coverage and HPV Vaccine for Adult Beneficiaries – April 2007

5

Medicaid Coverage of HPV Vaccine for ages 21-26

WA

OR

ID

MTND

WYSD

MNWI

MI

IL INOH

PA

NY

ME

CA

NVUT

CO

NE

KS

IA

MOKY

WVVA

NC

TX

NMAZ OK AR

LA

TNSC

GA

FL

ALMS

NJ

RI

CT

VT

MA

NH

AK

HI

DE

MDDC

Source: GWU/SPHHS Medicaid Coverage and HPV Vaccine for Adult Beneficiaries – April 2007

Covered (n = 22)

Not Covered (n = 22)

Unknown (n = 7)

6

States that Provide Free/Low Cost HPV Vaccine (n=9)

WA

OR

ID

MTND

WYSD

MNWI

MI

IL INOH

PA

NY

ME

CA

NVUT

CO

NE

KS

IA

MOKY

WVVA

NC

TX

NMAZ OK AR

LA

TNSC

GA

FL

ALMS

NJ

RI

CT

VT

MA

NH

AK

HI

DE

MD

DC

Source: GWU/SPHHS Review of Standing Orders – February 2007

As of 05/24/07

7

STATES THAT PROVIDE FREE/LOW COST HPV VACCINE (n = 9)

STATE ELIGIBLE POPULATION

ARKANSAS Females ages 9 through 18

MICHIGAN Females ages 9 through 26

MISSOURI 5,000 females ages 9 through 26

NEVADA Females ages 9 through 26 ADULTS: $140/dose CHILDREN: $20/dose

NEW HAMPSHIRE Females under age 19

OREGON Females ages 9 through 12 who are uninsured or underinsured

ELIGIBLE SITES: FQHC or health dept FEES: Waivable administration fee

SOUTH DAKOTA Females ages 11 through 18. If patient turns 19 after Dose 1, may continue series. ELIGIBLE SITES: Various

WASHINGTON Females ages 9 through 18

94,000 doses available for 31,000

FEES: Administration feed up to $15.60, plus office visit charge

WISCONSIN Priority: Females ages 11 & 12. Others: Contact provider or health department

FUNDING SOURCES: 317 Program Grants, VFC, Medicaid, State Funds

Source: GWU/SPHHS/DHP/05/07

8

• State mandates convert recommendations into legally enforceable obligations

• Power to mandate: 10th Amendment “police power”

• Most effective strategy to ensure full access to vaccines

• Laws are variable:• Medical standard may fail to require ACIP• Opt-out language• Lack of enforcement of existing law

• ½ of nation is considering requiring HPV vaccine• 1 state (VA) requires the vaccine for girls entering 6th grade• District of Columbia: Awaiting Mayoral and Congressional approval

School Immunization Requirements

9

Mandating HPV Vaccine for School Entry

WA

OR

ID

MTND

WYSD WI

MI

ILOH

PA

NY

ME

CA

NVUT

CO

NE

KS

IA

MO VANC

TX

NMAZ OK AR

LA

TNSC

FL

ALMS

NJ

RI

CT

VT

MA

NH

AK

HI

DE

MD

DC

Source: WomeninGovernment.org/prevention As of 05/07/07

MO KY

WV

MN

IN

HPV Vaccine School Requirement Introduced (n = 23)

HPV Vaccine School Requirement Enacted (n = 2)

Executive Order blocked by legislature (n = 1)

GA

10

Proposed Legislation to Require Private Insurance Coverage of HPV Vaccine (n = 16)

WA

OR

ID

MTND

WYSD

MNWI

MI

IL INOH

NY

ME

CA

NVUT

CO

NE

KS

IA

MOKY

WVVA

TX

NMAZ O

KAR

LA

TNSC

GA

FL

ALMS

NJ

RI

CT

VT

MA

AK

HI

DE

MD

DC

Source: Womeningovernment.org/prevention As of 05/07/07

NH

PA

NC

INTRODUCED: Compulsory Insurance Coverage of HPV Vaccine

11

Federal policy recommendations from 6/06 support broad access to HPV vaccine

FEDERAL PROGRAMS: • Adopted federal recommendations: VFC, Medicaid, SCHIP, 317

STATE ACTIVITY:• PUBLIC HEALTH PROGRAMS: Less than ¼ participate in special

HPV vaccine campaigns

• SCHOOL MANDATES: 1/2 of states have addressed mandating HPV vaccine, only 1 state has legislation in place

• HEALTH INSURANCE COVERAGE: 1/3 of states are considering mandating coverage for HPV vaccine

Summary: Access to HPV Vaccine