Many parents hoping to get their daughters a new cervical cancer vaccine at their back-to-school checkups are winding up disappointed.
The expensive shots — while recommended by a panel of experts — are often hard to find or not yet covered by insurance.
At her 14-year-old daughter’s checkup last month, Lisa Abolt learned that while her doctor strongly recommends the vaccine, she hadn’t ordered supplies. The pediatrician, Dr. Aleta Clark, said that’s because of uncertainty over whether many health insurers will cover the $360 cost of the three-shot series. Clark recommends patients return in January, when she believes most insurers will be on board.
“I’m trying not to stick families with the bill,” she said.
Abolt wants the shots for her 11-year-old daughter, too, and said getting both girls vaccinated is a no-brainer.
“If there’s something out there that could protect against something down the line, why wouldn’t you get the vaccine?” Abolt said. “I want to get it as soon as it becomes available — but I would also like insurance to cover it.”
The vaccine, Merck & Co.’s Gardasil, has been hailed by many doctors as a breakthrough in cancer prevention. It prevents infections from four strains of the sexually transmitted human papilloma virus, or HPV, which can cause cervical cancer, other genital lesions and genital warts.
About 6 million Americans are diagnosed each year with HPV, which is among the most common sexually transmitted diseases. It infects men and women, but because cervical cancer is the most serious consequence, the vaccine currently is recommended for women and girls only.
Chicago pediatrician Dr. Donald Brown said patients and parents who have seen television ads and other consumer marketing about the shots “have been asking about this like no other vaccine that I can recall.”
Brown said he’s offering it despite insurance uncertainties, and is billing insurers, not patients, with his fingers crossed.
“We don’t know about the insurance, but it’s good medicine,” he said.
“This is a big school season, kids are coming in to get high school physicals and college physicals, and if we don’t catch them now we’ll have to wait a year,” Brown said Monday.
The vaccine was approved in early June for use in girls as young as 9, up to age 26. A government advisory panel’s recommendations later that month said that ideally the vaccine should be given before girls become sexually active; for those already exposed or infected by one HPV strain, the vaccine can offer protection against other strains.
Some major health insurers including Aetna, Cigna and Wellpoint say they already offer coverage for Gardasil. Others have said they will but are waiting for the federal Centers for Disease Control and Prevention to adopt the advisory panel’s recommendations — something that’s expected to happen in November, said Mohit Ghose, spokesman for America’s Health Insurance Plans, a trade group for insurers.
Still, it could take insurers and doctors several months to work out contracts and reimbursement issues for the expensive vaccine, Ghose said.
Gardasil is at least twice as expensive as three-shot vaccines for other diseases. That’s because of research and development costs and its value as a public health tool, said Merck spokeswoman Kelley Dougherty. She said the vaccine is available in all 50 states but would not discuss the amount ordered or already shipped to doctors’ offices.
Some doctors, Planned Parenthood offices and community clinics are waiting to order the vaccine when it becomes available for uninsured youngsters through the government’s Vaccines for Children program. Some, too, are waiting until it is recommended by the American Academy of Pediatrics, which is expected to follow the CDC’s lead.
While a lag between approval and official government policy on vaccines is normal, the delays have lasted months with several recent shots, creating “a kind of limbo” for many doctors, said Dr. Jonathan Temte of the American Academy of Family Physicians.
Temte said his group plans to discuss speeding up its own recommendations instead of waiting for the CDC.