Multiple Vaccines: How Do We Choose?

BACKGROUND: As preventive medicine is a cornerstone of managed care, most health plans have traditionally featured automatic vaccine coverage routed through the medical benefit. However, with the advent of emerging vaccines, managed care stakeholders must revise decision-making processes and choose among multiple products targeting the same disease. OBJECTIVES: To review the motivating forces behind traditional vaccine coverage in managed care and discuss the need for managed care organizations (MCOs) to subject their vaccine policies to greater examination in the changing landscape of emerging vaccines. SUMMARY: While variable vaccine coverage or choices in vaccine coverage is a relatively novel concept in managed care, the evaluation of vaccines in this setting is usually most effectively performed via a traditional route for MCOs: the Pharmacy and Therapeutics (P&T) committee. In some cases, a technology assessment committee is a more appropriate avenue for evaluation, depending on the disease state, administration, and plan infrastructure. Through these routes of evaluation, criteria similar to those used for other pharmaceutical agents under review should be employed in the review of vaccine options. The primary criteria evaluated include safety, efficacy, cost, and value. In addition, a set of miscellaneous factors must also be considered, including both tangible and intangible components. For example, the relevance of an agent to the specific covered population, compliance costs offsets, quality-of-life considerations, and both patient and provider demand should all be taken into account. Human papillomavirus vaccination provides a pragmatic example for applying the aforementioned strategy for vaccine evaluation in managed care. CONCLUSIONS: The changing landscape of vaccine coverage in managed care, particularly in the availability of novel agents, demonstrates a need for MCOs to subject their vaccine policies to much greater examination. Through traditional avenues such as P&T and technology assessment committees, stakeholders should seek to evaluate standard criteria such as safety, efficacy, and cost-effectiveness, with additional considerations made for factors unique to the preventive nature of vaccines.