Pneumococcal Vaccine/$$$

June 21, 2000

Glad they're making it hard so peds won't buy it...

Sheri

**********************

From PPVA....

HMO Doctors' Catch-22 on Baby Vaccine

/20/ED81509.DTL

" YOU MIGHT have read that the American Academy of Pediatricians has just

recommended the new pneumococcal vaccine for all children under age 2. The

Centers for Disease Control is about to recommend it, too, at its meeting

this week. The vaccine will help prevent 1 million ear infections a year in

the United States, 53,000 cases of pneumonia and 12,000 cases of meningitis

and bacterium. And researchers predict it will save the lives of 116

children each year.

So you take your baby to the pediatrician for the first of four doses. You

hand the receptionist your usual HMO co-payment, make an appointment for the

next dose and go home.

Yet this vaccine, so simple and straightforward on the surface, points up

(once again) the inconsistencies and contradictions that roil behind the

scenes in managed care.

Your pediatrician, for example, has had to buy a minimum of 1,000 doses of

the new vaccine to get the pharmaceutical company's wholesale rate of $58

per dose -- an outlay of $58,000. Because he's in the middle of his HMO

contract, and because the new vaccine wasn't included as a reimburseable

expense in the contract, the HMO has no obligation to reimburse him -- even

though the pediatrician is now required to administer it. "

--------------------------------------------------------

Sheri Nakken, R.N., MA

ANY INFO OBTAINED HERE NOT TO BE CONSTRUED AS

MEDICAL OR LEGAL ADVICE. THE DECISION TO

VACCINATE IS YOURS AND YOURS ALONE.

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