Every November, like clockwork, she receives the same letter, said Lindsay Irvin, a pediatrician in San Antonio.
It is from the pharmaceutical company Pfizer Inc., and he informs them that the price of the pneumococcal vaccine Prevnar 13 is increasing. Again.
And that makes her angry.
“They’re the only ones who are successful,” she says. “It’s like buying gas in a hurricane – or Coke in an airport. They charge what they want. “
The Advisory Committee on Immunization Practices (ACIP), an advisory group to the federal Centers for Disease Control and Prevention, recommends Prevnar 13 for all children under 2 years of age – given at 2, 4, 6, and 15 months – as well as for adults 65 and older.
It protects against pneumonia as well as ear infections and other infections. Many states require proof that children have received the vaccine to attend school.
The vaccine’s formulation has remained virtually unchanged since its federal approval in 2010, but its price continues to rise, increasing by around 5% or 6% in most years. In just eight years, its cost has climbed by more than 50%.
It is one of the more expensive vaccines that Irvin provides to his young patients.
Doctors and clinics buy the vaccine and then, once they inject patients, they usually recoup the cost through patient insurance coverage. In most cases, there is no charge to pay.
But steadily rising prices for brand-name drugs are indirectly contributing to rising premiums, deductibles and government health spending, analysts say.
A complete pediatric cycle of the vaccine usually involves four injections. In 2010, a single shot cost around $ 109, according to pricing records kept by the CDC. It currently costs around $ 170, according to these records. Next year, according to Pfizer, a shot will cost nearly $ 180.
“Pfizer and other drug companies are raising their prices because they can,” said Gerard Anderson, a professor of health policy at Johns Hopkins University who studies drug prices. “They have a patent, and they have a recommendation from the CDC, which is a double whammy – and a strong incentive to raise prices.”
The company disagrees – saying vaccine pricing supports research into new vaccinations, as well as continued efforts to keep products safe and improve their effectiveness. For example, the shelf life of Prevnar 13 has increased from two to three years this year. Pricing does not affect access either.
“Thanks to comprehensive guidelines from health authorities, Prevnar 13 is one of the most widely available public health interventions, supported by broad insurance coverage and innovative federal programs that ensure access to vulnerable populations,” said Pfizer spokesperson Sally Beatty in an email.
But such arguments do not justify the “constant price increases” model, suggested Ameet Sarpatwari, an epidemiologist and lawyer at Harvard Medical School who studies drug policy.
“Does that explain what is happening?” Probably not, ”he says. “It is up to them to show us why this is necessary.”
Consumers are unlikely to directly feel a pinch of these increases. The Affordable Care Act requires vaccines recommended by ACIP to be covered by insurance, without cost sharing.
There are other implications, however.
Higher vaccine prices make it harder to supply doctors, noted Michael Munger, a family doctor in Overland Park, Kan., And president of the American Academy of Family Physicians.
They have to buy vaccines in advance to provide them to patients. Insurance will pay them off eventually – usually at cost – but it can take months for this to materialize, which is an especially difficult proposition for small practices with tight budgets.
“You have to keep track of your inventory, make sure you don’t have any waste and that you’re going to get a proper refund,” he said. “The cost of vaccines is definitely something of concern to us in primary care because we are on tight margins. … You don’t want to provide a service that you waste money on, even if it is as important as the vaccination.
Gardasil, the HPV vaccine, has also seen its price rise. And, in a similar response, OB-GYNs provide it in smaller numbers.
A vaccine like Prevnar 13 is more difficult to make than older vaccines that are much cheaper, said William Moss, a professor at the Johns Hopkins Bloomberg School of Public Health, specializing in vaccines and children’s global health. It provides immunization for 13 different variations of pneumococcal infection. This makes it a more effective vaccine, but also a vaccine that requires a larger investment.
Critics, however, note that these investments were made by another company, Wyeth Pharmaceuticals. Pfizer bought Wyeth in 2009, along with the rights to the vaccine.
Kaiser Health News (KHN) is a non-profit news service covering health issues. This is an editorially independent program of the Kaiser Family Foundation which is not affiliated with Kaiser Permanente.