HMO to Be Investigated for Not Pushing Chickenpox Vaccine
The state of California said Tuesday it will investigate whether PacifiCare of California is violating state law by refusing to recommend a chickenpox vaccine to its members.
The HMO, a subsidiary of Cypress-based PacifiCare Health Systems Inc., has come under fire from a consumer group for failing to endorse the widely accepted preventive measure.
The vaccine has been on the market since last May, and federal guidelines recommend vaccinations for young children and others with a high risk of contracting the disease.
PacifiCare covers the vaccination as a health benefit, but the company doesn’t recommend it, a policy that the state Department of Corporations says may violate state law. The law requires HMOs and other health-care providers to follow federal recommendations.
The HMO’s policy places its members in the difficult position of having to keep up with “every new and latest technology coming in” and to “ask for it with every procedure,” said Damian Jones, a spokesman for the state agency.
The company’s policy has come under sharp criticism from Consumers for Quality Care in Santa Monica. It is an attempt to “redefine medical science” to save “a few bucks,” said Jamie Court, the organization’s director.
The group accused PacifiCare of discouraging the vaccine’s use. The company’s written policy says it “is not recommending or endorsing routine, universal vaccination” for the disease.
Dr. William Osherhoff, the HMO’s medical director, said that while PacifiCare covers the vaccination as a health benefit, the company as a policy doesn’t recommend it because of medical, not financial, considerations.
“We cover appendectomies, but we don’t recommend those for everybody either,” he said, adding, that state law doesn’t require HMOs to promote the vaccination but only to provide coverage.
About 3.7 million Americans contract the generally mild disease each year, according to the federal government. For some, though, chickenpox is a serious illness. About 9,300 patients are hospitalized each year with chickenpox, and 50 to 100, mostly young children, die. About a year ago, New Jersey drug giant Merck & Co. received regulatory approval to market the first chickenpox vaccine domestically. Thus far, 2 million doses have been sold.
The vaccine has been recommended by leading government and medical authorities.
Osherhoff contends that researchers have yet to prove whether the vaccine will prevent the disease from occurring throughout a person’s life.
Merck said PacifiCare is the only HMO it knows about that isn’t recommending immunizations.
