Billing third party payers for vaccines: state and local health department perspectives

Area of Science:

• Public Health
• Health Economics
• Vaccinology

Background:

• Childhood immunization costs are increasing due to new, expensive vaccines.
• Federal funding for vaccines faces challenges, with Section 317 funds lagging behind rising costs.
• Local health departments struggle to fund vaccines for children ineligible for the Vaccines for Children (VFC) program.

Purpose of the Study:

• To address funding shortfalls for childhood immunizations.
• To explore innovative funding mechanisms for state immunization programs.
• To assess the feasibility of billing health plans for vaccines administered in public clinics.

Main Methods:

• The Oregon Immunization Program (OIP) initiated a project to bill health insurance plans for vaccines.
• Local health departments billed health plans for vaccines given to insured, eligible children.
• Section 317 funds were conserved by this billing initiative.

Main Results:

• The OIP project successfully generated revenue by billing health plans.
• Significant savings were achieved in Section 317 funds.
• Conserved funds allowed for increased vaccine provision to high-need populations.

Conclusions:

• Billing health plans for vaccines administered to covered individuals is a viable strategy.
• This approach can alleviate pressure on federal vaccine funding sources like Section 317.
• The OIP model demonstrates a sustainable method for ensuring vaccine access for all children.