Aetna U.S. Healthcare has agreed to pay California doctors the costs of any new vaccines recommended by the American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). Aetna will pay for the vaccines for a period of up to one year following the initial recommendations.

The move will encourage physicians to routinely administer Prevnar, a vaccine that helps prevent potentially fatal pneumococcal infections in young children and lessens outbreaks in the general population. "Vaccines are unique, as they benefit the health of the public as well as that of the individual child," says Dr. Lucy Crain, chairperson of the AAP's California district.

Aetna's policy is consistent with the California Association of Health Plans' recent efforts to have insurers — either voluntarily or through legislation — cover the costs of new vaccines when they have been approved after annual contract negotiations with provider groups.

The U.S. Food and Drug Administration (FDA) approved Prevnar in February, a few months after member physicians had signed new contracts.

Aetna is the first California health insurer to issue a blanket policy statement regarding the reimbursement of new vaccines such as Prevnar, according to Karen Nikos, a spokesperson with the California Medical Association (CMA). "Other insurers are just handling the issue on a case-by-case basis," she says.

Physician and parent groups are lauding the policy change. "This commitment by Aetna shows that health plans and physicians can sit down together to find solutions that are in the patient's best interest," says Dr. Jack Lewin, the CMA's chief executive officer.

According to the AAP, the decision to pay for new vaccines will remove the financial barriers that dissuade doctors from administering the innoculations. Some physicians had been holding off ordering Prevnar until it had become clearer whether insurers such as Aetna, the nation's largest health care provider, would pay for the vaccine outside of "capitation" agreements. Under capitation, an insurer pays primary care physicians a fixed rate per patient.

Nationally, Aetna U.S. Healthcare follows the recommendations of the AAP and the ACIP in covering new vaccines. These vaccines usually are covered on a fee-for-service basis. However, payment for the new vaccines became an issue in California because so many independent physician associations (IPAs) operate in the state and the IPAs have different contract agreements with Aetna that do not allow for the direct reimbursement of costs of the new vaccines.

At $58 per dose, Prevnar is the most expensive vaccine given to children under age 2. Adding it to the usual arsenal of childhood innoculations may double physicians' immunization costs because each child requires four shots, adding $232 to the total cost of routine innoculations.