About 20 million people in the United States are affected by HPV, a sexually transmitted virus, which can lead to cervical
cancer, and 6.2 million new cases are reported annually, according to the Centers for Disease Control and Prevention (CDC).
According to a survey of 300 women aged 25 and older conducted by AllPoints Research, Winston-Salem, N.C., 69% are unaware
of the root causes of HPV and only about 60% have even heard of HPV. Of those who have, 52% link it to cervical cancer and/or
genital warts. However, 72% say that they would approve of the administration of the HPV vaccine to their 12-year-old daughters
if they had a daughter that age. Of the 28% in opposition to the vaccine, 35% say that 12 years old is too young, while another
35% worry that the vaccine would promote sexual activity. INSURERS CHOOSE COVERAGE Among the insurers that cover the new vaccine are Regence Blue Shield of California headquartered in San Francisco and CDPHP
in Albany, New York. "Not only is Gardasil the first HPV vaccine approved by the FDA, but it marks a shift from therapies that are used for the
treatment of a condition to one that is aimed at prevention," Nishida says. "It may potentially reduce the burden of diseases
caused by HPV." Regence generally charges a standard administration fee for the injectable. As for the challenges, Nishida points to studies prior to FDA approval that showed an increase in pre-cancer related to the
vaccine in the people who already had these infections before they got the vaccine. The FDA, however, determined that this
population of women had more risk factors for developing cervical disease. When a new vaccine hits the market, CDPHP studies clinical evidence and recommendations and then makes a decision, says Cliff
Waldman, MD, vice president, medical affairs for the insurer, which covers the vaccine without requiring a copayment. "It
is considered a preventive care service consistent with our other preventive health guidelines." In September, CDPHP covered
the vaccine for female members ages 9 to 19, but revised its guidelines in December, extending it to age 26, as recommended
by ACIP. Blue Shield of California, which also follows the recommendations from ACIP and the U.S. Preventive Services Task Force, covers
the HPV vaccine 100% for eligible members. John Yao, MD, the plan's medical director, believes that the vaccination is more
effective before a girl has any sexual activity; thus, Blue Shield of California approves Gardasil for females ages 9 to 26.
With reportedly low reimbursement from insurers, physicians are said to be hesitant to stock Gardasil. According to USA Today, most insurers are only reimbursing $2 to $15 over the $120 dose charge, forcing some physicians to access a surcharge. Horizon
Blue Cross Blue Shield is reimbursing physicians $150 per dose plus a $21.50 administration fee for staff time, office overhead,
syringe disposal and supplies. CIGNA also has raised its reimbursement rate for the vaccine. Mari Edlin is a frequent contributor to MANAGED HEALTHCARE EXECUTIVE She is based in Sonoma, Calif. Visit us ONLINE For our Pharmacy Best Practices library, visit http://www.managedhealthcareexecutive.com/
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