Recombinant Zoster Vaccine (RZV/Shingrix): Who to give it to and how to get it paid for
Nuts and bolts:
- RZV is more than 95% effective vs. only 50% for live attenuated zoster vaccine (LAZV/Zostavax). (With large reduction in postherpetic neuralgia.)
- Starting at age 50 it is recommended for everyone. (No max age to stop offering it.)
- RZV is a 2-part series. Injections should be separated by at least 2 months.
Recommend to everyone over age 50 even if:
- they have had clinical shingles in the past
- they have received LAZV in the past
- they are immunocompromised (RZV is not a live vaccine, unlike LAZV)
- Do NOT give RZV to transplant patients without consulting their transplant specialist. (Could adjuvant be so immunogenic that it could trigger a transplant rejection?)
- RZV is not approved for use in pregnant women. (although antigen is safe, nobody knows about adjuvant)
Who pays for it and how?
- Medicaid & Medicare – they cover it; must give it at a pharmacy. (UWMC-Roosevelt Pharmacy OK if before 4pm)
- Regence/UMP and Anthem– will pay for it to be given at a pharmacy OR in the clinic
- Other commercial plans – generally pay for it to be given in a clinic (not at a pharmacy)
If ordering to be given in clinic at GIMC (for patients with commercial insurance and Regence/UMP):
- Order RZV in EPIC as a PROCEDURE, not as a MEDICATION
- Prepare for 20-40 minute wait for vaccine to be brought up from pharmacy
- Discuss with MA at huddle, discuss with patient at start of appointment, order early
If ordering to be given at a pharmacy (for patients with Medicare Part D, Medicaid, Regence/UMP, or Anthem):
- Order RZV in EPIC as a MEDICATION, not as a PROCEDURE
- Very hard for UWMC-Roosevelt pharmacists to give after 4:00pm (short staffed)
- If done at UWMC Pharmacy, pharmacist will log vaccine as given in Epic
Side effect reactions:
- 80+% get soreness at injection site
- 30-50% get mild systemic symptoms
- 10-15% get very strong flu-like rxn to adjuvant.
- 2nd dose identical to 1st dose.
- Consider advising patientsto receive first shot on a Friday to allow weekend recovery time