What are you paying to be vaccinated?
What is your insurance company paying for you to be vaccinated?
Many of us have never thought about the costs associated with a vaccination because our insurance covered it, the co-pay was low, or maybe it was free. Some may think this topic is silly and does not apply to them. This discussion applies to all of us because we are all paying for these fees in our high insurance premiums, reduced coverage, and higher out-of-pocket costs.
In May 2019 I had a checkup with a physician at a large medical group with over 45 offices (Ulster County to New York City) and over 600 physicians.
At that appointment I was advised that I should strongly consider getting the Gardasil 9 vaccine because I was 44 years old and the age limit had recently been raised to 45. The doctor told me that even though I am married, that spouses die, people get divorced and situations change. Gardasil 9 is a three shot vaccination series used to prevent HPV, a virus that can lead to certain types of cancer. The doctor said I had to act quickly because I would have just enough time to get the shots in before my 45th birthday. At that visit I was given the first Gardasil 9 shot and a Tetanus shot.
At the end of September 2019 I received a bill for the vaccinations that were administered in May:
Gardasil 9 (shot #1) – $419
Administration Fee – $15.09
Tetanus shot – $32.05
Administration Fee – $19.75
I paid my bill thinking that the $419 must be for all three Gardasil shots and that the only thing I should have to pay in the future would be the two additional administration fees. (Note: My insurance did not cover these vaccination charges).
On December 3, 2019 I received a new bill for $438.75. I thought it was a mistake, but I was informed that these were the charges for the second shot.
Gardasil 9 (shot #2) – $419
Administration Fee – $19.75
I have yet to be billed for the final shot administered in November, but the charges will be the same as the bill received on December 3, 2019 and the total will be for $438.75.
I have since had many discussions with this practice and its representatives. They claim the doctor did not know my insurance would not cover the vaccines, and that the doctor did not know what she charges for a dose of the Gardasil 9 vaccine. They told me that I should have known to ask the price, and perhaps I should have. However, doctors give injections and vaccines because they are a profit center for their practice. If it were not profitable they would likely send you to your county health department, CVS/Walgreens, or another local pharmacy.
I have done some research following this most unfortunate situation and the information I have uncovered is worthy of investigation by the highest powers.
Gardasil 9 Pricing
The CDC Vaccine Price List — updated on Dec. 2, 2019; private sector contract price for Gardasil 9 (sold in a pack of 10) is $227.931 or $22.79 per shot. (Private sector prices are those reported by vaccine manufacturers annually to CDC.)
The CDC Vaccine Price List — updated on Dec. 2, 2019; CDC cost for Gardasil 9 (sold in a pack of 10) is $144.99 or $14.49 per dose. (Contract prices are those for CDC vaccine contracts that are established for the purchase of vaccines by immunization programs that receive CDC immunization cooperative agreement funds — i.e., state health departments, certain large city immunization projects, and certain current and former U.S. territories).
Cardinal Healthcare (a wholesaler) sells Gardasil 9 (a pack of 10) to CVS for $2279 or $227.93 per dose. 1000% more than the private sector contract price of $227.93.
A large physician group in IL purchases Gardasil 9 (a pack of 10) for $1382.30 or $138.23 per dose and sells it for $210 per dose. A 65% profit.
The NY group practice I received the vaccine from will not disclose their cost. It charges patients $419 per dose. Three dose total $1257. If this group can purchase the vaccine for the same price as the practice in IL, their profit would be 203%. If however, they paid $227.93 per dose as CVS does, their profit would be 84%.
$165.33 per dose is price if you have the GoodRx Gold discount card. Costs range from $168.95 (Hannaford) with coupon to $210 at CVS.
How much profit is too much and by whom?
Our healthcare system is broken. This is part of why it is broken. People complain that it’s the drug companies, but for Gardasil 9 and other vaccines, it is the wholesaler/middleman and the doctor overcharging the patient and their insurance company.
In 2018, according to the annual report of Merck & Co Inc., they sold $3.152 billion in Gardasil/Gardasil 9.
In fiscal year 2019 Cardinal Healthcare’s Pharmaceutical Segment did $129.9 billion in revenue and $1.8 billion in profit according to their annual report.
How does a shot of Gardasil 9 go from $22.79 to $419 per shot and be accepted as okay?
Merck sold $3.152 billion of Gardasil/Gardasil 9 last year. If the price was raised 1000% ($22.79 to $227.90) as it is by just the wholesaler (Cardinal Healthcare), we are talking about $31.52 billion dollars charged back to patients directly or indirectly for a single vaccine. The cost grows exponentially when you then add the additional profit margins of the doctors and pharmacies that administer the vaccine. A shot of Gardasil at $419 per dose is a 1739% profit to all parties involved. This is ultimately charged back to the public in fees and higher premiums.
This pricing situation is not isolated to one particular vaccine.
The CDC private sector contract price for Tetanus (TDVAX – sold in pack of 10) is $25.122 or $2.51 per shot. Tetanus (Adacel – sold in pack of 10) is $45.50 or $4.50 per shot and Tetanus (Boostrix – sold in pack of 10) is $41.19 or $4.19 per shot. Regardless of the tetanus used, is a charge of $32.05 for a shot justifiable?
The EpiPen scandal was over the price increase from $100 for a two-pack in 2009 to $608 in 2016. This was a 508% increase over multiple years. This scandal resulted in Congressional hearings and a national outcry.
Are our vaccinations any less important?
I strongly encourage you to be informed. I thought that my doctor would have informed me that the vaccine was expensive or that it might not be covered by insurance. The doctor said nothing and now the practice is unapologetic for the bill of $1257 for this three shot vaccine. These are the people that take an oath to do no harm. They are your neighbors, family and friends. Making money is one thing, but is there not an ethical responsibility on the part of all parties involved to keep the cost of vaccines at a responsible price?
Where are the Congressional hearings to address the profits of the wholesalers?
Where is the ethical responsibility of our providers to dispense vaccines at a cost that does not qualify as price gouging?
Why are we as patients okay with all of this and when will our elected officials help us stop the bleeding?