In June 2014, Alaska Senate Bill 169, which authorized the formation of a statewide vaccine assessment account, was signed into law. The intent of this new law is to preserve universal access to state-distributed vaccines for children and to provide state-distributed vaccine for covered adults.
Effective January 1, 2015, the vaccine assessment account will be forward-funded through vaccine payments from payers (e.g., private and public health care insurers, health benefit plans, and third-party administrators), and will be overseen by an independent vaccine assessment council. Payers will be assessed based on their proportionate share of the overall vaccine costs. The Alaska Immunization Program will then use the account funds to purchase vaccines at a discounted rate from a bulk contract and distribute pediatric and adult vaccines to health care providers statewide.
Although many other states have already created similar vaccine financing solutions, below are some of the distinctive features of the Alaska law that might benefit policy makers in other states who would like to pursue similar legislation in the future.
- Adult Vaccines: Alaska’s new law allows assessments for both pediatric and adult vaccines. State-distributed vaccine will be available to providers for all children and adults who are covered by participating payers. Most other states that have similar programs only allow for the purchase of pediatric vaccines.
- The Model: The two primary models under consideration for the Alaska assessment are the “covered lives” model (e.g., Idaho) and the “dosage-based assessment” model (e.g., Washington). Alaska’s new law is not prescriptive in terms of which model should be used; rather, it allows Alaska’s Vaccine Assessment Council the flexibility to make this determination.
- Phase-in Period: Under procedures approved by the DHSS Commissioner, an assessable entity will be able to opt-out of the program during a 3-year phase-in period. The effective dates will likely be on January 1 each year during 2015–2017.
- Mandatory Participation: The law mandates participation—after the 3-year phase-in period—from all assessable entities, to the extent participation in the program is authorized by law. This includes Employee Retirement Income Security Law (ERISA) plans and publicly funded coverage like Medicare, Medicaid, and TRICARE. While publicly-funded healthcare benefit plans are included in the law’s definition of a health care insurer, it is currently unclear whether this law can require these entities to participate in the assessment program after the 3-year phase-in period, as federal law might prohibit such a mandate for at least some of the plans. Any federal plans that cannot be required to participate might still be able to opt-in to the assessment; those that are not able or willing to opt-in will need to continue directly purchasing vaccine for those clients not covered in the assessment by another payer.
- Provider Opt-in: Providers will receive, at no cost, state-supplied vaccine purchased with vaccine assessment funds. Unique to the Alaska model, providers who care for uninsured adults can benefit from the state’s bulk purchasing power by opting-in to the program at any time. This provision offers providers a more cost-effective way to fund vaccines for their uninsured adult patients.
- Pharmacists: Pharmacists with a collaborating physician licensed in Alaska will be able to receive state-distributed vaccine for all children and adults who are covered by participating payers. Pharmacists can receive state distributed vaccine for uninsured adults if they opt-in to the program.
- Alaska’s Vaccine Assessment Council Responsibilities: The Alaska Vaccine Assessment Council will be established within the Alaska Department of Health and Social Services. Responsibilities of the Council include determining 1) the method for calculating the assessment amount; 2) the method for determining proportional costs to payers; 3) procedures for collecting and depositing assessment fees; 4) procedures for collecting data, which includes at a minimum the number of covered individuals and vaccine usage; and 5) developing a system for crediting overpayments. The council will consist of eight members appointed by the DHSS Commissioner; all members will serve without compensation for up to two 3-year terms.
The Alaska Immunization Program is committed to working with providers to make as much state-supplied vaccine available to Alaskans as possible in an equitable fashion. More information about this Law is available at www.epi.alaska.gov under the “Spotlights” section, “Vaccine Assessment Account FAQ” link.
Joe McLaughlin is the State Epidemiologist of Alaska and CSTE President-Elect.