Question Gardasil over 26


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I have a provider who wants to provide Gardasil to patients up to Age 45. Trying to explain to him that yes FDA has changed the age to 45, but that does not mean insurance are on board with paying for those over 26. Any feedback I can have on this matter would be great. Anybody started billing for those over 26? Are you getting paid or denied? If denied what is the reason? Which insurances are denying them? Does anyone have any written decision from insurances on this matter?

Pam Brooks

True Blue
Local Chapter Officer
NAB Member
South Berwick, ME
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Just because the FDA has approved the use of Gardasil up to age 45 doesn't mean that payers are on board. So you can provide the vaccine, but you do need to let your patients know that it might not be covered. Contact your major payers and find out what their policy is----it will vary by payer, by state so what happens here in NH is going to be irrelevant to you. Then show your provider their payment policies, so he understands the financial risk of providing the vaccine when insurance won't cover. If you decide to go ahead and vaccinate anyway, you have to consider this a cash transaction. You can submit to payers but you're probably not going to get paid, so getting your $$ up front as long as your patients are aware and still want the vaccine, is the best approach.