Investigate third party coverage for the costs and administration of the immunizations you plan to offer. Patients may be enrolled in employer-provided health insurance plans, or private insurance plans that have limited vaccine reimbursements. It is important to communicate with the insurance carriers most often used by the patients in your practice to verify vaccine coverage and administration. Reimbursement varies by insurance carrier. Some insurance plans do not cover preventive medicine services , in which case, administration of vaccines may not be covered. If the plan does not cover immunizations, it is important to inform patients so they are prepared for “out-of-pocket” payment. Tracking payment of insurance claims is an invaluable tool in assessing coverage for immunization services. Federal regulations provide for all CDC recommended vaccines and routine immunization coverage of persons up to 21 years of age covered under the Medicaid program and the Children’s Health Insurance Program . This coverage is for low-income families and which families are covered varies on a state-by-state basis. Medicare, the federal program for those over 65 or disabled, currently covers the administration of three vaccines: influenza (once per influenza season), pneumococcal polysaccharide and booster for high risk persons (once per lifetime), and hepatitis B. Medicare does not cover other immunizations unless they are directly related to the treatment of an injury or direct exposure to a disease or condition (e.g. tetanus, rabies exposure).
The practice may be able to obtain free or discounted vaccines to reduce overhead costs. Vaccines for Children (VFC) is a federal program that provides free vaccine for all persons from birth through 18 years (until their 19th birthday) who meet VFC criteria. Contact the VFC coordinator at your local and state health department for eligibility requirements for patients in this age range. The VFC website has helpful information addressed to providers. As an added benefit, the state immunization program staff may be able to provide on-site assistance in setting up your office immunization program. Another useful strategy is to join with other providers for bulk or group purchasing which generally lowers the per-unit costs of vaccines and supplies,
For updated vaccine costs, visit CDC’s vaccine price list.