Childhood Immunization:

Opportunities to Improve Immunization Rates at Lower Cost

HRD-93-41: Published: Mar 24, 1993. Publicly Released: Apr 5, 1993.

Additional Materials:

Contact:

Sarah F. Jaggar
(202) 512-7119
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

Pursuant to a congressional request, GAO examined options to reduce Medicaid costs for immunizing children.

GAO found that: (1) nine states have established vaccine replacement programs in which health agencies purchase low-cost vaccines through the Centers for Disease Control and Prevention (CDC) contracts and supply them free to Medicaid providers; (2) ten states purchase low-cost vaccines from CDC and distribute them to all providers for Medicaid and non-Medicaid use; (3) Medicaid reimbursements for commercially purchased vaccines are considerably higher than CDC-contract prices, which cost states $12.7 million in 1990; (4) Medicaid continues to reimburse health departments for the costs of vaccines only after they have administered vaccines to children, therefore, states must purchase the initial supply of vaccines; (5) an alternative vaccine replacement program would have manufacturers contract with states to provide vaccines directly to physicians to mitigate start-up and distribution problems; (6) if states required the use of combined rather than single-antigen vaccines, further savings could be achieved; and (7) to improve immunization levels, immunization programs need to educate parents on the importance of immunizations for their children and tracking and following up on each child's immunization status.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: This recommendation was superseded by the President's Childhood Immunization Initiative in OBRA 1993.

    Recommendation: To expand access to immunization services, the Secretary of Health and Human Services should direct the Assistant Secretary for Health and the Administrator of the Health Care Financing Administration (HCFA) to develop innovative financing mechanisms through Medicaid and CDC immunization program grants to support wider implementation of vaccine replacement programs.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Not Implemented

    Comments: OBRA 1993 takes a slightly different approach, directing HHS to negotiate contracts for the purchase and delivery of vaccines for all federally-eligible children.

    Recommendation: To expand access to immunization services, the Secretary of Health and Human Services should direct the Assistant Secretary for Health and the Administrator, HCFA, to strongly promote wider adoption of vaccine purchase and distribution programs that allow states to purchase vaccines directly from manufacturers at CDC prices.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Not Implemented

    Comments: Under the Vaccines for Children program, HHS is pursuing a different strategy that supersedes this recommendation.

    Recommendation: To address a barrier to physician participation in immunizing Medicaid children, the Secretary of Health and Human Services should direct the Administrator, HCFA, to specifically assess the adequacy of fees paid to providers for administering vaccines as part of the agency's evaluations of state compliance with provisions of the Omnibus Budget Reconciliation Act of 1989 (Section 6402) on adequate payment levels for obstetrical and pediatric services.

    Agency Affected: Department of Health and Human Services

  4. Status: Closed - Not Implemented

    Comments: Under the Vaccines for Children program, HHS is pursuing a different strategy that supersedes this recommendation.

    Recommendation: To reduce Medicaid vaccination costs, the Secretary of Health and Human Services should direct the Administrator, HCFA, to require that requests for Medicaid reimbursement of single-antigen vaccines for preschool children include medical justifications.

    Agency Affected: Department of Health and Human Services

 

Explore the full database of GAO's Open Recommendations »

Sep 15, 2016

Sep 14, 2016

Sep 12, 2016

Sep 9, 2016

Sep 6, 2016

Aug 31, 2016

Looking for more? Browse all our products here