Vaccines for Children (VFC), Child Health Plus and Private Insurance Coverage of Quadrivalent Human Papillomavirus (HPV) Vaccine for Males

November 18, 2011

To

Health Care Providers and Local Health Departments

From

New York State Department of Health, Bureau of Immunization

On October 25, 2011, the Advisory Committee on Immunization Practices (ACIP) voted to expand the routine use of quadrivalent HPV vaccine (HPV4, also known as Gardasil). The expanded recommendations for HPV4 vaccination include:

  • Routine vaccination of adolescent boys 11 – 12 years of age,
  • Catch-up vaccination of males 13 – 21 years of age,
  • Permissive use of vaccine among males 9 – 10 and 22 – 26 years of age, and
  • Routine vaccination of men ages 22 – 26 years who have HIV infection or who have sex with men.

ACIP also updated the federal Vaccines for Children (VFC) Program resolution for HPV vaccine to allow routine use and catch up vaccination with HPV4 for VFC-eligible boys 9 – 18 years of age.

As a result of these changes:

  • New York State boys 9 – 18 years of age who are VFC-eligible (i.e. children who are Medicaid/Medicaid Managed Care recipients, uninsured, or American Indian/Alaskan Native) or who are enrolled in Child Health Plus may receive publicly purchased HPV4 in their medical homes.
  • New York State boys 9 – 18 years of age who are considered "underinsured" under the State's expansion provision of the VFC program (i.e., insurance does not cover HPV4) may also receive publicly purchased HPV4 in their medical homes.
  • Under New York Insurance Law, private insurance plans regulated by New York State are now required to cover HPV4 for boys 9 – 18 years of age.
  • Some private insurance plans also cover HPV4 for men 19 – 26 years of age. Providers should check with private insurance carriers, prior to administering vaccine, to verify coverage.

The complete VFC Resolution on HPV vaccine is available at http://www.cdc.gov/vaccines/programs/vfc/downloads/resolutions/10-11-1-hpv.pdf.

New York State Insurance Department Circular Letter No. 13 (2006) on Coverage for Preventive and Primary Care Services is available at http://www.dfs.ny.gov/insurance/circltr/2006/cl06_13.htm