Article

Most Medicaid Plans Cover HPV Vaccination for At-Risk Adults With Dermatologic Conditions

Author(s):

An analysis of Medicaid coverage found that Mississippi was the only state not to provide coverage for human papillomavirus (HPV) vaccination in adults aged 27 to 45 years.

Human papillomavirus (HPV) vaccination is covered by most state Medicaid plans in adults aged 27 to 45 years, with and without the need for prior authorization (PA), which can bolster protection against infection amongst at-risk populations with certain dermatologic conditions. Findings of the research letter were published recently in JAMA Dermatology.

HPV vaccination is approved by the FDA for all individuals aged 9 to 45 years for the prevention of genital, cervical, anal, and oropharyngeal cancers, as well as genital warts, noted researchers.

Current recommendations by the CDC and Prevention Advisory Committee indicates that routine vaccination should be provided for those aged 9 to 26 years, whereas shared clinical decision-making is recommended in individuals aged 27 to 45 years because benefits may still exist for adults at high risk for new HPV infection.

Certain populations within the 27 to 45 year age group who may be at increased risk for persistent and high-risk HPV infection (ie, associated with an increased risk of cancer) include those with hidradenitis suppurativa, atopic dermatitis, and systemic lupus erythematosus. Although these at-risk patients may particularly benefit from vaccination, the authors said that a lack of firm recommendations makes insurance coverage for this age group uncertain.

Researchers conducted a cross-sectional study to assess state Medicaid coverage policies on the HPV vaccine among adults aged 27 to 45 years and examine the feasibility of dermatologists recommending vaccination to adults at risk. US Medicaid policies for all 50 states was used as a proxy for coverage of the insured population in the United States, with data collected from September 14 through December 8, 2021.

“Information concerning coverage, age restrictions, and PA requirements was recorded from state Medicaid formularies and policies via websites and email or telephone inquiries,” they explained.

A 3-step process was used to determine coverage in the 50 states:

  • Step 1: Examined state Medicaid formularies and online databases—33 states had formal statewide policies for adult HPV vaccination coverage available online or by contacting the state Medicaid office
  • Step 2: Contacted state health departments to determine existence of adult vaccination program—4 states had formal adult vaccination programs that covered vaccination
  • Step 3: Identified Medicaid managed care organization—11 states provided coverage through Medicaid managed care organizations
  • Information was unavailable for 2 states (Arkansas, Missouri)

Overall, HPV vaccination was covered in 43 states (86%) through age 45 years without the need for PA, with PA being required by 4 states (Ohio, Maine, Nebraska, and New York) for adults over the age of 26 years. Mississippi did not provide coverage to adults older than 26 years.

Based on findings, researchers said that such widespread coverage should assist dermatologists as they recommend vaccination to adults at high risk and facilitate the incorporation of HPV vaccination into disease-specific management guidelines. But state Medicaid policies may change over time, they cautioned.

Limitations of the study included the use of Medicaid coverage only as patients with other types of insurance or who are uninsured may face additional barriers, such as cost. The current retail price for the 3-shot series was noted to be $250 to $300 per shot.

“In addition to the increased prevalence and persistence of high-risk HPV infection seen in adults with certain dermatologic condition, patients who are immunosuppressed (eg, those taking tumor necrosis factor inhibitors) have been found to be at increased risk for persistent HPV infection and HPV-related cancer,” they concluded.

“Further research is needed to better identify dermatology patients at risk for new HPV infection and ways to improve vaccination rates in these vulnerable individuals,” they concluded.

Reference

Goldman N, Nwankwo C, Charrow AP, Noe MH. State Medicaid coverage of human papillomavirus vaccination in adults and implications for dermatologists. JAMA Dermatol. Published online October 26, 2022. doi:10.1001/jamadermatol.2022.3500

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