Childhood Immunization

Most state Medicaid programs could save money if low-cost vaccines acquired through contracts with the Centers for Disease Control (CDC) were made available to all doctors giving vaccines to poor children. Although state and local health departments can buy low-cost vaccines for this purpose, most do not. State Medicaid programs have ended up reimbursing providers for vaccines that cost as much as five times the CDC-contract price. These state programs could also reduce immunization costs if they reimbursed providers only for the combined measles, mumps, and rubella vaccine rather than the higher cost individual vaccines. Savings on vaccine costs, however, will do little to improve preschool immunization levels unless funds are provided to educate parents and track and follow up on the immunization status of children. Most states do not systematically carry out these activities.

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

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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