N.C. kids may get 5 more free shots

Plan would have insurers foot bill

Eleven-year-old Kathryn Covington pushed up the sleeve of her pink shirt Wednesday and submitted to five shots in the shoulder -- vaccinations against bugs such as hepatitis A, meningitis and the virus that causes most cervical cancers.

North Carolina has been a leader in immunizing children such as Covington. Its N.C. Universal Childhood Vaccine Distribution Program offers all children access to free vaccines. Now it wants to expand its menu.

The state Division of Public Health wants to raise about $36 million to add five vaccines to the universal program, which is credited with helping North Carolina achieve one of the nation's highest childhood immunization rates. Thousands of North Carolina children may be going without the newer immunizations, including the meningitis and cervical cancer vaccines Covington got. Those shots are not part of the universal program, which provides vaccines at no cost to private doctors and public health clinics.

Some private practices are reluctant to offer shots not in the universal program, because they must buy the vaccine themselves and risk losing money if insurers won't cover it all. It's not an insignificant concern, doctors say, when some newer shots retail for between $80 and $120 a dose.

Bills introduced at the General Assembly would authorize the state to impose a new fee on health insurers. The money raised would enable the state to purchase vaccines at discounted federal prices, saving as much as 20 percent off retail, according to numbers provided by the state.

Health plans, whose members get free vaccines through the universal program, benefit from the arrangement because it allows them to stretch the money they now spend on the newer vaccines, said Dr. Leah Devlin, state health director.

"More families will have access to the vaccines, health plans are getting a better price and medical cost savings from preventing illness, and the manufacturers of the vaccines will be selling more product," Devlin said.

Blue Cross and Blue Shield of NC, the state's largest health insurer, and the N.C. State Health Plan, the largest employer-funded health plan, both support the state's plan for expanding the childhood vaccine program, at least in theory. Dr. Don Bradley, Blue Cross's chief medical officer, said the cost of expanding the program must be spread fairly among health plans and should not be so high that it becomes a burden to members. A large fee could result in higher premiums, which Blue Cross would not support, Bradley said.

Added protection

The expansion would add five vaccines to the universal program, including shots that protect against pneumonia and related illnesses, diarrhea-causing rotavirus, bacterial meningitis and the virus that causes cervical cancer. The additional funding would also help pay for the state to buy more seasonal flu vaccine to immunize children between the ages of 2 and 5, who last year were added to the list of people who should get annual flu shots.

The expansion would remove cost from the decision-making process when private doctors consider adding the new vaccines. Some practices don't routinely offer more expensive vaccines such as Gardasil or Menactra, which provides 10 years of protection against meningitis and retails for about $88 a dose. Others warn patients that they might get stuck with the bill if insurance companies won't pay.

White Oak Pediatric Associates in Raleigh, for example, asks parents to sign forms to that effect for any vaccine it has to purchase and bill insurance for, said practice administrator Lou Ann Thomas.

"No one wants to get stuck with an inventory they can't pay for," said Dr. John Rusher, a partner in Raleigh Pediatrics and member of the state's Immunization Advisory Panel. "But if mom or dad comes in and is asked to pay up front, or if they're asked to sign a waiver agreeing to pay if we can't get reimbursed, some of them are going to balk and say, 'I don't think we need that vaccine'."

When that happens, immunization rates decline, Rusher said.

For example, only about 61 percent of children get vaccinated as recommended with Prevnar, a series of shots not included in the universal program. It protects against pneumonia, bacterial meningitis and middle-ear infection in children. By contrast, about 91 percent of children receive recommended vaccinations for diphtheria, tetanus and whooping cough -- a combination shot the program provides free to doctors.

Money is a factor

Raleigh Pediatrics, where Kathryn Covington is a patient, doesn't ask parents to sign waivers before administering the newer vaccines, because it is confident the insurers it contracts with will at least cover costs. Lynda Covington of Raleigh, Kathryn's mother, said it would have given her pause to know she might have to pay out-of-pocket. Kathryn got two shots -- Gardasil and Menactra -- that are not part of the universal program. The bill for both would exceed $200.

"I might have put it off for a year or two," said Covington.