ACCESSING HPV VACCINE: Preliminary Progress Alexandra Stewart, JD Department of Health Policy

1. ACCESSING HPV VACCINE: Preliminary Progress Alexandra Stewart, JD Department of Health Policy Contact: stewarta@gwu.edu June 2, 2007

2. ACIP* Recommendations Trigger 3 Avenues to Access FEDERAL FUNDING: • Ensured access to vaccines through VFC and 317 • Ensured access to vaccines through Medicaid, SCHIP PRIVATE MARKET FUNDING: • Increased access to vaccines through private health insurance coverage STATE STATUTES: • Increased access to vaccines through school entry requirements * Advisory Committee of Immunization Practices

3. Public Funding of Vaccines • VACCINES FOR CHILDREN (VFC) • Free vaccines to age19 who are: • Uninsured, underinsured, Medicaid eligible, American Indian, Alaska native • MEDICAID EARLY, PERIODIC SCREENING, DIAGNOSIS & TREATMENT(EPSDT) • STATE CHILDREN’S HEALTH INSURANCE PROGRAM (SCHIP) • Covers ACIP-recommended vaccines for children in families with incomes that • are too high for Medicaid, but have no insurance. States set age limitations for • program eligibility. • SECTION 317 • Awards grants to state, local, & territorial public health agencies for program operations and vaccine purchases. Limited funds available for vaccine purchase • PUBLIC HEALTH CLINICS • Some states provide free or low-cost vaccines to the uninsured (children or adults)

5. Medicaid Coverage of HPV Vaccine for ages 21-26 VT NH WA ME MT ND MA OR MN AK SD WI RI NY MI ID WY PA NJ NE IA OH NV IL IN DE UT WV CT VA CA CO KS MO KY MD NC DC TN AZ AR SC OK NM GA MS AL LA TX FL Covered (n = 22) Not Covered (n = 22) Unknown (n = 7) HI Source: GWU/SPHHS Medicaid Coverage and HPV Vaccine for Adult Beneficiaries – April 2007

6. States that Provide Free/Low Cost HPV Vaccine (n=9) VT NH WA ME MT ND MA OR MN NY AK SD WI RI MI ID WY PA IA NJ NE OH NV IL IN DE UT WV CT VA CA CO KS MO MD KY NC DC TN AZ AR SC OK NM GA MS AL LA TX FL HI As of 05/24/07 Source: GWU/SPHHS Review of Standing Orders – February 2007

8. School Immunization Requirements • State mandates convert recommendations into legally enforceable obligations • Power to mandate: 10th Amendment “police power” • Most effective strategy to ensure full access to vaccines • Laws are variable: • Medical standard may fail to require ACIP • Opt-out language • Lack of enforcement of existing law • ½ of nation is considering requiring HPV vaccine • 1 state (VA) requires the vaccine for girls entering 6th grade • District of Columbia: Awaiting Mayoral and Congressional approval

9. Mandating HPV Vaccine for School Entry ME VT NH WA MT NY ND MA MN OR AK SD WI RI MI ID WY PA IA NJ NE OH IN IL NV DE UT WV CT CA CO KS MO MO VA MD KY NC DC TN AZ AR SC OK NM MS GA AL LA TX FL HPV Vaccine School Requirement Introduced (n = 23) Executive Order blocked by legislature (n = 1) HI HPV Vaccine School Requirement Enacted (n = 2) Source: WomeninGovernment.org/prevention As of 05/07/07

10. Proposed Legislation to Require Private Insurance Coverage of HPV Vaccine (n = 16) ME NH VT WA MT ND MA OR MN NY AK SD WI RI MI ID WY PA NJ NE IA OH NV IL IN WV DE UT CT VA CA CO KS MO MD KY NC DC TN AZ OK AR SC NM GA MS AL LA TX FL INTRODUCED: Compulsory Insurance Coverage of HPV Vaccine HI Source: Womeningovernment.org/prevention As of 05/07/07

11. Summary: Access to HPV Vaccine • Federal policy recommendations from 6/06 support broad access to HPV vaccine • FEDERAL PROGRAMS: • Adopted federal recommendations: VFC, Medicaid, SCHIP, 317 • STATE ACTIVITY: • PUBLIC HEALTH PROGRAMS: Less than ¼ participate in special HPV vaccine campaigns • SCHOOL MANDATES: 1/2 of states have addressed mandating HPV vaccine, only 1 state has legislation in place • HEALTH INSURANCE COVERAGE: 1/3 of states are considering mandating coverage for HPV vaccine