“It’s more complicated to fix the fragmented US health care system that creates big barriers to Beyfortus access for some kids, O’Leary said. That system is structured such that many pediatricians have to take huge financial risks to keep Beyfortus in stock. For patients who get care at those practices, access will likely be a little touch-and-go until demand also stabilizes and pediatricians can better forecast how much to stock.
Why is it so risky for some pediatricians to stock certain immunization products?
It has to do with who’s paying for the products, and how much they cost. Pediatric vaccines are paid for and distributed in the US through two main mechanisms. About half of American kids get vaccines paid for by the federal government through a program called Vaccines for Children, or VFC. The program’s goal is to ensure cost isn’t a barrier to vaccinating kids, so eligibility is restricted to kids who are Medicaid-eligible, under- or uninsured, or American Indian or Alaska Native.
The other half of American kids get vaccines paid for by private insurance companies, but only after the pediatrician administers it. What insurance companies pay for each vaccine isn’t always enough to cover its full cost, and the pediatrician often doesn’t know how much an insurance company will pay them for a vaccine until after the fact.
This setup means ordering any vaccine is somewhat of a financial risk to pediatric practices. But because most vaccines are relatively cheap, and because their familiarity to most parents makes demand relatively predictable, the risk is relatively small.
The math is totally different for Beyfortus, though: One dose costs a doctor’s office nearly $500 — and as a totally novel immunization, its popularity was hard to forecast. “For a medium-sized practice, they might have to spend $250,000 to cover their patient population,” O’Leary said. “And that is not money they have lying around.””
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“A universal vaccination program that made vaccines available across the lifespan, free of charge, would be wonderful, O’Leary said, and it’s what other industrialized countries like Canada and the United Kingdom do. “But that’s not where we are,” he said.”