Payment Barriers Persist for Vaccinating Providers

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Summary

Following policy changes addressing vaccine coverage gaps, stakeholders are focusing on provider financial and administrative barriers to vaccination.

Vaccinating providers’ ability to offer vaccines to patients is impeded by several financial and administrative barriers, including ongoing concerns with payment rates across payer types and sites of care. These providers often invest resources up-front to stock and administer vaccines to patients with the intent of recouping these costs through reimbursement (Figure 1). 

Figure 1. Example of a Provider Journey to Vaccinate an Adult Patient

ACIP: Advisory Committee on Immunization Practices; IIS: Immunization Information Systems 

Concerns about varied payment rates may contribute to provider uncertainty about timely reimbursement and could further factor into decisions about whether to continue stocking and administering vaccines over the long term. 

Policymakers and stakeholder advocates are considering potential reforms that aim to alleviate these challenges. The goal of these proposed reforms is to improve vaccine access across care settings and provider types and, ultimately, increase adult vaccination rates. As payment reform potentially becomes increasingly relevant with the launch of new vaccine delivery methods, advancing certain reforms may require coordinating alignment across partner advocates and additional evidence generation to garner policymaker support. 

Download the white paper, Examining Provider-Focused Vaccine Policy Reforms: Considerations for Patient Access. 

To learn more about Avalere’s vaccine work and efforts to expand vaccine access in adult populations, connect with us.   

Funding for this research was provided by the Adult Vaccine Access Coalition. Avalere retained full editorial control. 

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