Cost and Insurance Coverage for the HPV Vaccine Gardasil

See if you or your child can get the vaccine at no cost

HPV vaccine
HPV vaccine. Getty Images/Peter Dazeley/Photographer's Choice

The HPV vaccines, Gardasil, Gardasil 9, and Cervarix, protect against the types of human papillomavirus (HPV) that cause cervical cancer and genital warts. The vaccine is specifically recommended for both boys and girls ages 11 or 12, though others can benefit from its protection. How much does this vaccine cost? The good news is that it should be covered at no cost by most insurance plans and the Vaccines for Children (VFC) program for those who are eligible.

Who Should Be Immunized

HPV is a virus that is sexually transmitted. HPV 16 and HPV 18 have been identified as the viruses most likely to cause genital warts and cancer. Besides children age 11 or 12, young women can get the HPV vaccine through age 26 and young men can get the vaccine through age 21 if they were not adequately vaccinated previously. It is also recommended for men ages 22 through 26 if they have certain immunocompromising conditions or have sex with men or are a transgender person who was not adequately vaccinated previously.

What Does Gardasil Cost?

Under the Affordable Care Act (ACA), the Gardasil 9 vaccine should be provided without cost for both males and females in the recommended age groups by all covered private insurance plans and the insurance obtained through the health exchanges as of 2017. Changes to or repeal of the Affordable Care Act could result in changes to the vaccine benefit offered by insurance companies.

The vast majority of health insurance providers cover Gardasil, but that varies from company to company. Merck, the manufacturer of the vaccine, recommends contacting your insurer to ask whether it is covered, what restrictions there might be, how much you will have to pay, whether there are deductibles that apply, and if there is an annual coverage maximum that will apply.

Gardasil is covered under the Vaccines for Children program, a federal program available to children through age 18 who are uninsured, Medicaid-eligible, American Indian, Alaska Native, or underinsured. This makes the vaccine free to eligible children. Those over age 18 may be covered by Medicaid and it may vary by state. In states where the Children's Health Insurance Program (CHIP) is separate from Medicaid, the vaccine is covered. You may need to go to a public health clinic to get the vaccine if your doctor is not enrolled as a VFC provider.

A patient paying out of pocket for Gardasil may pay over $190 per dose as of 2017. Three doses are required over a six-month period, making the total cost for the HPV vaccine $570 or more. On top of that, some doctors chqrge office visit fees when the vaccine is given.

Merck has a patient assistance program and offers the vaccine at no cost for adults of ages 19 to 26 who do not have health insurance and cannot afford to pay for the vaccine.

Sources:

Assistance Programs for Those Who Aren't Covered. Merck. https://www.gardasil9.com/insurance-and-support/assistance-programs/.

CDC Vaccine Price List. CDC. https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html.

HPV Vaccine Information for Clinicians. Centers for Disease Control and Prevention. https://www.cdc.gov/hpv/hcp/need-to-know.pdf.

Should I Get the HPV Vaccine? Planned Parenthood. https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/hpv/should-i-get-hpv-vaccine.

The HPV Vaccine: Access and Use in the U.S. The Henry J. Kaiser Family Foundation. http://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in/

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