Cost and Insurance Coverage for the HPV Vaccine Gardasil

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 recommended for boys and girls between 11 and 12 (though it is approved for ages 9 through 45). Notably, only Gardasil 9 is available in the U.S.

Updated HPV vaccination guidelines from the American Cancer Society (ACS) recommend routine vaccination beginning at age 9 in an attempt to make sure more kids get the vaccine sooner rather than later. Although the vaccine is approved for use in people up to age 45, the ACS recommends against giving it to those older than 26 as most people have been exposed to HPV by that age, rendering the shot ineffective.

Although Gardasil 9 has a price tag of between $400 and $500 for a three-dose schedule, the good news is that the vaccine 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 cancer, while strains 6 and 11 are the strains most likely to cause genital warts. 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 9, 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 VCF 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.

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.

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Article Sources
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  1. U.S. Food and Drug Administration. Gardasil 9. Updated June 24, 2020.

  2. Saslow D, Andrews KS, Manassaram-baptiste D, Smith RA, Fontham ETH. Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation. CA Cancer J Clin. 2020; doi: 10.3322/caac.21616.

  3. Kaiser Family Foundation. The HPV vaccine: Access and use in the U.S. Published on October 9, 2018

  4. Centers for Disease Control and Prevention. VFC eligibility criteria. Last reviewed on December 17, 2014

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