New Merck Programs Address Uncertainty of Insurance Coverage for HPV Vaccination

Merck & Co. Inc. is launching two new programs for its quadrivalent human papillomavirus, or HPV, vaccine, in an attempt to take the uncertainty out of insurance coverage issues for patients and payment issues for physicians.

According to the CDC, early data indicate only about 10 percent of eligible, privately insured women ages 18-26 have received the first dose of the three-dose series for Merck's HPV vaccine, which is sold as Gardasil.

Merck sources say some physicians are reluctant to provide same-day Gardasil vaccinations to women in this age group because of uncertainty about insurance coverage. Instead, physicians are encouraging patients to ask their health plans whether the vaccine's costs are covered. Patients then can return to their physicians for vaccination. The uncertainty about coverage, combined with a lack of follow-up by patients, has contributed to low vaccination rates in this age group.

Merck's new Confidence in Coverage Status program will provide doctors with patients' benefit information before office visits. Participating physicians will determine which of their privately insured 19- to 26-year-old female patients who are scheduled for office visits in the next one or two weeks are candidates for vaccination with Gardasil. They then can submit these patients' names, birth dates and insurance information to Merck online or by faxing the information to (866) 209-9051.

Within three to five days, physicians can expect to receive faxed reports that include coverage status and, if applicable, copay, coinsurance and deductible amounts.

Merck said the service, provided by Covance Market Access Services, complies with requirements of the Health Insurance Portability and Accountability Act.

Merck also is launching a second program, dubbed the Patient Rebate Program for Gardasil. In this program, eligible privately insured 19- to 26-year-old female patients who receive Gardasil doses from April 1, 2009, through April 30, 2010, will be eligible for a rebate when their out-of-pocket costs for Gardasil exceed $30 per dose. The maximum rebate is $130 per dose. Patients must file for the rebate within 90 days from the date each dose was administered. Merck says patients will receive the rebate within six to eight weeks of submission.

Physicians can request rebate forms to distribute to patients by calling (800) GARDASIL [427-3274].

Compliance with certain terms and conditions is required. Uninsured patients, patients covered by government-funded programs, and residents of Colorado and Massachusetts are not eligible for the rebate program.