The Advisory Committee of Immunization Practices (ACIP), a committee within the Centers for Disease Control and Prevention, previously considered the human papillomavirus (HPV) vaccine preventive for individuals aged 9 through 26 years. However, on August 15, 2019, the ACIP updated their recommendation to include an expanded age recommendation for HPV vaccination and now recommends HPV vaccination based on shared clinical decision making for individuals aged 27 through 45 years who are not adequately vaccinated.
As of August 15, 2019, AmeriHealth began covering the HPV vaccine as a preventive service with $0 cost-share (i.e., copayment, deductible, and coinsurance) for individuals aged 9 through 45 years, consistent with the ACIP recommendations listed below.
9-valent human papillomavirus vaccine (9vHPV) is considered medically necessary and, therefore, covered for the following individuals:
- Routine two-dose regimen of 9vHPV for individuals 11 years or 12 years of age administered 6 – 12 months apart. The vaccination series is covered beginning at 9 years.
- Individuals who begin the vaccination series at age 15 years through 26 years are covered for the three-dose regimen of 9vHPV vaccine.
- Catch-up vaccination for females age 13 years through 26 years who have not been vaccinated previously, who have not completed the three-dose series, or with primary or secondary immunocompromising conditions that might reduce immunity. If a female reaches age 26 years before the vaccination series is complete, remaining doses will be covered after age 26 years.
- Catch-up vaccination for males 13 years through 26 years of age who have not been vaccinated previously, who have not completed the three-dose series, or with primary or secondary immunocompromising conditions that might reduce immunity.
- Vaccination when indicated by shared clinical decision-making for individuals 27 years through 45 years who are not adequately vaccinated.
For more information, refer to the following news article and medical policies:
To view the news article and these policies, visit our Medical Policy Portal.