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    The real ROI of immunizations

    Vaccinating my patients almost killed my practice last year. I didn’t have to read the 2012 American Academy of Pediatrics (AAP) article to know that the actual cost of providing vaccinations, including purchase and storage, is 17% to 28% more than the price we pay for the vaccine. That has been the case for most of my 20 years in independent practice.


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    The problem is that the cost of recommended vaccines has skyrocketed while the reimbursement (based on wholesale prices that are not available to my small-volume clinic) often doesn’t even cover the vaccines’ purchase price. Vaccinations are now the second-most expensive item—after payroll—for most practices of my size, and based on data from the AAP study, reimbursement can be up to 47% less than the actual purchase cost to the practice. How did we get here?

    In 2015, when we were recommended to provide the already-expensive PCV13 pneumonia vaccination to all seniors, the price my clinic paid for that vaccine suddenly increased. Now it is almost 40% more than prior to the Advisory Committee on Immunization Practices recommendation. The same thing happened in 2005 when TDaP boosters were recommended for all adults, and again in 2016 when the HPV vaccine indication was extended for all children.


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    Independent practices like mine can’t take advantage of the volume discounts and promotions offered to larger groups. As I watched my clinic’s credit card balance rise, I asked our pharmaceutical sales representatives why vaccine prices go up rather than down with increased production. I never received a satisfactory answer—production problems, increased regulations and market forces were their most common explanations.

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    • [email protected]
      This has been my experience also.I have contacted some insurance companies to ask how they determine the reimbursement rates for some of these vaccines. I was given purchase prices well below the prices that I pay even as a member of a vaccine purchasing group. When I asked which supplier offered these lower vaccine prices, since this is the supplier from which I wish to order, dead silence! I know of no business in which one is reimbursed below the cost of purchasing supplies .This is totally unacceptable since, as mentioned in this article, vaccine purchase is the second highest expense for a small practice. Earlier in my private pediatric practice vaccines were actually a reliable source of revenue.

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