Do your kids need the HPV vaccine — and does your health insurance cover it?
You might think no one would question making a life-saving vaccine widely available. But the controversial human papillomavirus (HPV) vaccine carries widespread political, social and health insurance complications.
The basics of HPV
Genital human papillomavirus, often called HPV, is the most common sexually transmitted disease (STD), according to the federal Centers for Disease Control and Prevention (CDC). More than 40 HPV types can infect both males and females and are transmitted via sexual contact. These different types of HPV can cause a variety of health problems, from genital warts to cancer.
Most people who become infected with HPV don’t even know they have it, since many do not develop symptoms or health problems. In 90 percent of cases, the body’s immune system clears HPV naturally within two years, according to the CDC. There’s no way to know which people who get HPV will develop cancer. But when HPV does result in cancer, it’s deadly. Cervical cancer strikes about 12,000 U.S. women a year and kills about 4,000.
|A vintage-style ad from 2008 promotes the Gardasil vaccine for HPV.|
In 2006, the U.S. Food and Drug Administration (FDA) approved an HPV vaccine for females age 9 to 26. Three years later, the FDA approved it for males in the same age range. Today, two vaccines are available: Cervarix from GlaxoSmithKline and Gardasil from Merck. Although they aren’t affective against all strains of the virus, they lower a patient’s chances of getting HPV and developing associated health problems.
Insurance coverage for HPV
The HPV vaccine is given in a series of three doses, generally costing about $130 each, according to the CDC. Health insurance plans that cover vaccinations typically include the HPV vaccine. And patients with a health plan that took effect after March 23, 2010, might be able to get it for free.
The federal health care reform law requires that in-network preventive procedures, including the HPV vaccine for women and girls, be covered without cost-sharing (no deductible, no co-pay).
Things are more complicated for males. Although the FDA approved the vaccine for boys and men in 2009, it wasn’t recommended by the CDC until October 2011 — and the CDC’s stamp of approval often guides private insurance coverage. It’s up to the U.S. Department of Health and Human Services to determine whether HPV vaccinations for males will be among the preventive health services covered without cost-sharing.
Women who have “grandfathered” health insurance plans also may run into some complications. Grandfathered plans are those that existed before the health care reform law was signed and that don’t have to comply with many of the health care reform law’s rules — including the requirement to provide HPV vaccines without cost-sharing.
Those who are unsure about their coverage for HPV vaccines should check with their insurance companies about coverage, cost and age and gender restrictions.
“While many health plans cover HPV vaccinations, many also have age restrictions associated with their coverage,” says Amy Carter, a spokeswoman for Premera Blue Cross, which serves Washington state and Alaska.
Health insurance giants Aetna and CIGNA, for example, cover Gardasil and Cervarix for girls and women ages 9 to 26. They also cover Gardasil (but not Cervarix) for boys and men between 9 and 26.
Sexually active kids?
Experts say time is of the essence when it comes to preventing HPV. That’s because the vaccine provides the best defense when it’s given before the patient has the chance to contract the virus in the first place. The CDC recommends children get the vaccine at age 11 or 12.
“In order to decrease the spread of HPV, both boys and girls need to be vaccinated before they become sexually active,” says Dr. Peyman Banooni, an OB-GYN in Beverly Hills, Calif.
Because the HPV vaccine involves sex and adolescents, many consider it innately controversial. For parents, it may seem premature to vaccinate young people against a disease acquired as a result of sex.
“Many people are opposed to educating kids about anything sexually related in fear of giving them permission to become sexually active,” Banooni says.
The issue has become political. Republican presidential candidate Rick Perry, the governor of Texas, has been blasted for a 2007 failed executive order requiring all sixth-grade girls in the state to receive the vaccine unless their parents opted out. A report by Texans for Public Justice, a political watchdog group, found that both Perry as well as his biggest backer (the Republican Governors Association) had accepted donations from Merck, the maker of Gardasil.
In addition to accusing Perry of being in bed with a pharmaceutical company, Republican presidential contender Michele Bachmann used a September 2011 debate to liken mandatory HPV vaccination to “innocent little 12-year-old girls” being “forced to have a government injection.”
Virginia is the only state that mandates HPV vaccination for entering school, although parents can have their children exempted. Dozens of other states are debating whether to mandate the vaccine. As of November 2011, 41 states had introduced HPV-related legislation, according to the National Conference of State Legislatures.
Others are concerned about the safety of the HPV vaccine. Despite the HPV vaccine having been shown to be safe, those who identify with the anti-vaccine movement question whether we know enough about it. Still others question whether vaccinating against a disease that 90 percent of people won’t get isn’t overkill.
Health care professionals have concerns of their own.
“The one concern I have is that the vaccine only covers four of the most common HPV types,” says Banooni, the OB-GYN. “The concern is that over time, the other HPV types will become more prevalent.”