RZV/Shingrix Tip Sheet

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)

Small caveats:

  • 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 Anthemwill 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

Leave a Reply