Proposed Mandated Health Insurance Benefits
JLARC staff evaluate proposed health insurance mandates in support of the Special Advisory Commission on Mandated Health Insurance Benefits.
JLARC Report In Brief
Evaluation of HB 2877: Mandated Coverage of Human Papillomavirus (HPV) Vaccine
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States; an estimated 6.2 million persons are newly infected every year. Although the majority of infections cause no clinical symptoms, persistent infection with cancer-causing types of the virus can result in cervical cancer in women. HPV infection also causes genital warts and is associated with other cancers in both males and females. Gardasil, a vaccine which protects against four strains of HPV, was licensed by the U.S. Food and Drug Administration in June 2006. House Bill 2877 would require health insurers, health care subscription plans, and health maintenance organizations to provide coverage for HPV vaccination for all women and girls aged nine to 26. Separate legislation enacted by the 2007 General Assembly requires that rising sixth grade girls in Virginia public schools receive the vaccine beginning in October 2008.
Medical Efficacy and Effectiveness
The availability of a HPV vaccine offers an opportunity to decrease incidence of HPV infection, cervical and other related cancers, and genital warts in the United States. Several well-designed, clinically-controlled studies have illustrated high overall safety and efficacy in providing prophylactic protection against HPV infection. However, it will be decades before a reduction in cervical cancer incidence rates can be measured.
Social Impact
Use of the HPV vaccine in Virginia started after FDA approval in 2006, and is expected to increase significantly when legislation goes into effect in 2008 requiring all sixth grade girls attending Virginia public schools to receive the vaccine. In addition, the incidence of cervical cancer has decreased as the availability and utilization of cervical cancer screening has increased. The vaccine is the most expensive of the vaccines currently recommended by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices; however, both private insurance and public payer coverage is extensive. Given the wide availability of both the vaccine and provider coverage, many of the potential benefits of HPV vaccination will likely accrue in the absence of a mandate.
Financial Impact
Because coverage of the HPV vaccine is already widespread, the proposed mandate will not likely impact the overall cost of obtaining the vaccine. The proposed mandate is also not likely to significantly increase the number of females receiving the vaccine; public awareness campaigns and Virginia's vaccination requirement will likely have more of an impact. As a result of decisions by most insurance providers to cover the vaccination, it is anticipated that the impact on providers and total premium costs paid by Virginia's insured would be negligible, and have largely been incorporated into rates currently charged to customers.
Balancing Medical, Social, and Financial Considerations
The proposed mandate is consistent with the role of health insurance, as evidenced by the wide availability of coverage through both private and public providers. Medical experts also indicate that the cost of HPV vaccination is far outweighed by the costs of treating cervical cancer. Given the existing availability of coverage, the cost of mandating coverage under HB 2877 would be low. Mandating coverage would also be consistent with current State requirements for vaccination and funding allocated to HPV vaccination programs. However, the wide level of existing coverage of the vaccine suggests that a mandate may not be needed at this time. Additionally, it is unclear if coverage of HPV vaccines other than Gardasil would be included under the current wording of the proposed mandate. While there does not currently appear to be a need for mandating the coverage proposed under HB 2877, it may be prudent to monitor insurance coverage levels and consider whether a mandate is needed should coverage levels decline.
| Report No. 356: Sep 2007, 44 pages | Report (pdf) | Briefing (pdf) |