Goal 3: Maximize Access to HPV Vaccination Services

Ensuring that HPV vaccination is affordable and convenient for all U.S. adolescents will support optimal vaccine uptake. Access barriers likely play a role in low and uneven HPV vaccine uptake in the United States. These barriers—and approaches for addressing them—may differ across geographic regions, populations, and clinical settings. National, regional, and local efforts are needed to understand and address existing and potential barriers to access.

Coverage for HPV Vaccination Costs Must Be Maintained

The HPV vaccine is among the most expensive vaccines in the United States,1 but multiple sources of private and public financing ensure that the cost of the vaccine is covered for nearly all age-eligible adolescents.2 The Affordable Care Act requires private insurance plans and marketplace plans to cover all ACIP-recommended immunizations, including the HPV vaccine, with no consumer cost sharing.3 The vaccine also is available through the Vaccines for Children (VFC) Program for children under age 19 who are Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. HPV vaccine costs also are covered by Medicaid, state Children’s Health Insurance Programs, and Merck-sponsored patient assistance programs.2 The Panel Chair asserts that insurance coverage for preventive services must be maintained to ensure that cost does not limit U.S. adolescents’ access to HPV vaccination.

Alternative Settings May Expand Access to HPV Vaccination in Some Situations

Ideally, all adolescents would receive regular care—including immunizations—from a provider with whom they have an ongoing relationship. However, many adolescents do not receive regular preventive care through medical homes.4 In its 2012-2013 report, the Panel recommended that, for those adolescents, HPV vaccination be promoted and facilitated in venues outside the medical home, citing pharmacies and schools as potential sites within the “medical neighborhood” that could increase access to HPV vaccination. Since that time, these venues have been explored by various groups in different settings, and a clearer picture of the associated challenges and opportunities has emerged.

Both pharmacies and schools have potential to provide convenient access to HPV vaccination. Nearly 90 percent of U.S. residents live within five miles of a community pharmacy;5 pharmacies often have longer operating hours and shorter wait times than doctors’ offices and many provide walk-in vaccinations. Schools also provide the opportunity to reach the vast majority of adolescents, and school-based HPV vaccination programs have been highly successful in many countries around the world.6 In the United States, pharmacies and schools have not played major roles in HPV vaccination to date due to several challenges (see Challenges Associated with HPV Vaccination in Pharmacies and Schools).

Given these challenges, it is unlikely that HPV vaccination in pharmacies or schools will contribute to substantial increases in national HPV vaccination rates in the near future. However, alternative settings may expand access in some situations. Offering and promoting HPV vaccination in schools, pharmacies, and other sites within the medical neighborhood may be particularly useful in rural areas, which have fewer primary care physicians per capita than urban areas and greater obstacles to access.7 School-located programs have helped increase coverage rates in some areas (see School Program Increases HPV Vaccination in Rural North Dakota).8,9 The small but growing number of school-based health centers—which provide comprehensive healthcare services, have dedicated staff, and often serve large numbers of VFC-eligible students—may be able to more easily overcome the most common barriers to school-located vaccination.9,10

State and local laws, local cultural factors, potential partner organizations, and available resources should be considered when exploring options to increase access to HPV vaccination. Providers and programs in alternative settings should communicate and coordinate with primary care providers to the extent possible, including reporting all administered vaccine doses to the state’s immunization information system (IIS). The Panel Chair supports the call by the National Vaccine Advisory Committee11 for greater investment and commitment to promote interoperability of electronic health record systems and IIS. Once interoperability is achieved, states should consider requiring providers to report vaccinations to IIS to ensure that all vaccine providers have access to complete, timely information.

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