Rep. Smith proposes TRICARE reimburse UVP for childhood vaccines[/caption]
Participating in a cost cutting programs on providing vaccines to primarily children, 11 states participate in a Universal Vaccine Program (UVP) that purchases at discount rates vaccines via Centers for Disease Control (CDC) contracts with drug manufacturers. Finding that participating in this program is more cost-effective, all health care providers in those states have done so, except one. That one providers is TRICARE, that covers military personnel, that is not participating despite the children of military personnel receiving the benefits of the program in those states.
In an effort to remedy this problem, Rep. Adam Smith (D-WA) has introduced an amendment to the National Defense Authorization Act (H.R. 4909) that would require TRICARE to participate in, and reimburse those costs, to the UVP. These 11 states include Alaska, Connecticut, Hawaii, Idaho, Indiana, Maine, New Hampshire, New Mexico, Rhode Island, Vermont, and Washington. With the exception of low income, Native Americans or others covered by federal programs, the UVP provides vaccines for all children in those states.
Allowing children to receive vaccines according to the CDC schedule is among the reasons those 11 states have recognized the benefits from maintaining a stable vaccine supply. Because the states can take advantage of the CDC contract pricing for the vaccines and also lowering the administrative costs of the vaccines programs, they have found it more cost-effective to participate in the administration of childhood vaccines via the UVP.
The 11 UVP states worked with outside consultants to calculate the costs of those vaccines, which had been paid by those states, but after calculation of the costs, the major health insurance providers agreed to cover those costs because doing so allowed them to enjoy the 20 to 40 percent cost savings on the vaccines via the UVP.
TRICARE is the only health insurance provider that is not participating in UVP and reimbursing for those costs, which is causing higher costs to the UVP states and health care companies, which is leading in some instances to consideration of not providing UVP vaccines to U.S. military children covered by TRICARE.
TRICARE has accumulated more than $17 million in unpaid reimbursements for children that it covers receiving UVP vaccines in the past six years. Those 11 states are asking Congress to require that TRICARE cover this cost as have all the other health insurance providers. In discussion with representatives of KidVax, TRICARE has acknowledged that UCP saves money and has indicated willingness to work with UVP states, KidsVax, and Congress on resolution of this issue.
TRICARE claims it doesn’t have statutory authority to pay UVP reimbursements, because the programs are not TRICARE registered providers and all but Washington State does not assess payers on a per-claim basis. Congress can and should require TRICARE to pay it’s share for the UVP vaccines, and clarify TRICARE’s authority to make these payments regardless of the basis for which these assessments are billed. The past due assessments to UVP should also be paid by TRICARE.
Rep. Smith’s amendment should be adopted, and the savings realized by this program should be realized, for the benefit of all taxpayers covering the costs of childhood vaccines.]]>
