Health insurance mandates are used by industry to expand coverage and utilization of technologies. The mandate policy process raises questions about the optimal role for public health decision makers. Case studies of HPV testing mandates in three states examine the interaction between the public health community and industry throughout the policy process. Each mandate originated from a coordinated campaign to improve cervical cancer outcomes by increasing patient access to HPV technologies. Public health decision makers were not overtly involved in the policy development or analysis. In contrast, industry was intimately involved in each stage of the bill from inception, evidence development, building coalitions of support, mobilizing advocates and final passage. Sustained sales were not significantly higher in states where mandates were passed, though short-term increases were observed directly after passage.In the future, the public would benefit from public health decision makers who are working consistently, strategically and cooperatively with industry throughout the policy development process.

Dr. Garfield, Vice President at Bridgehead Interenational, is a market access, reimbursement and economics strategist with fifteen years experience in industry and consulting. Dr. Garfield received a BA from University of Pennsylvania, MSc from London School of Economics, SM from Harvard University, and a DrPH from Boston University.