Navigating Vaccine Price Increases

Frank Article Price Change

Originally posted by CPP Executive Director, Frank Combs, on LinkedIn.

Vaccine manufacturers typically increase pricing on vaccines annually. Vaccines are expensive and price increases give an opportunity to check the financial health of your practices’ vaccine administration program. Notifications of price increases can range from 30 – 90 days in advance depending upon how you purchase your vaccines. For example, if you purchase through a physician group purchase organization (PGPO) you can get advanced notice of increases. Let’s explore why this extra time is really helpful.

Financial analysis

First obtain the new pricing from the vaccine manufacturer, PGPO or distributor and download your payment data for each vaccine from your practice management system. Then compare the new pricing to your existing insurance payments. To make it easier, limit the analysis to your 3 – 5 largest insurance companies. This is the time to address any insurance payments that don’t meet your vaccine payment benchmarks or at the very least are below the cost of the various vaccines. The American Academy of Pediatrics (AAP) suggests that payment should be 10 – 25% over the direct cost of vaccines to cover all direct and indirect costs (see link below).


While the vaccine manufacturers typically notify the large insurance carries of their price increases, you should also notify your top 3 – 5 largest insurance providers. Insurance companies can take 60 – 90 days or more to load the increased payments into their systems, so the sooner you communicate with them the better. This also gives you an opportunity to address payments for specific vaccines that are not covering the cost of the vaccines as mentioned above.


Now it’s time to assess your vaccine needs by checking your purchase history, current vaccine inventory, storage capacity, and cash reserves. You’ll want to purchase as much vaccine during the notice period as your practice can afford before the new pricing goes into effect and without exceeding your storage capacity or placing cash reserves at risk. Practices that purchase a lot of vaccines can save thousands of dollars by doing this. Some practices have invested in additional vaccine storage refrigerators to expand their capacity and keep their vaccine stock safe. In addition, if you haven’t looked into purchasing your vaccines with a business credit card now is the time. There are a few credit cards that pay up to a 2% rebate on all purchases (50K in vaccine purchases would be a $1,000 rebate). The 30 day payment terms also gives your practice additional time to address any payment issues with payers.

Auditing & Resources

Remember to have whoever pays invoices in your practice check pricing and make sure the prices match the pricing announced by the vaccine manufacturers or sent out by your PGPO. Price increases can be a challenge for practices but with a little work you can maintain a financially viable vaccine administration program. Below are a few resources that should help you navigate these price changes.

The Business Case for Pricing Vaccines

CDC Vaccine Price List

CPP Vaccine Price Change Tools

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