DEAR DR. GOTT:
I am a registered pharmacist and immunization coordinator at a pharmacy in Wisconsin. I’m writing in response to one of your current articles regarding Zostavax, the shingles vaccine. I am hoping to help you clarify some of the issues that your reader brought up, as well as to update you on some current practices.

Forty-seven states now allow pharmacists to give a multitude of vaccines, such as influenza, pneumonia and shingles. Pharmacists who wish to provide this service must pass a national accreditation. This often involves showing how the vaccine is made, how to administer it, how to screen patients to determine who should not get the injection and what adverse effects may occur. Most pharmacists are certified in CPR and have the necessary medications on hand (to give while waiting for the ambulance) if an allergic reaction occurs.

This eliminates the middle man having to pick up the vaccine at the patient’s local pharmacy and bring it to a doctor’s office. I know this type of practice works in many situations, but because of the small window of time when the shingles vaccine is reconstituted, there is much room for error and a subsequent waste of the vaccine and money.

Also, you stated that Medicare does not cover the vaccine. Medicare part D, the prescription portion, does cover the vaccine at a co-pay to the patient. This works a lot like getting any other prescription at a pharmacy where you pay a portion of the cost, except that you are receiving a vaccine instead. We have had a lot of patients that want the vaccine and many are willing to pay the entire price if their insurance does not cover it.

Many of our patients read your column and hold your opinions with high regard, so thank you for addressing the shingles vaccine. You are correct that many physicians are staying away from giving the vaccine because of storage requirements and also because of the cost associated with holding the vaccine. Therefore, this has given immunizing pharmacists a niche in helping prevent painful diseases.

DEAR READER:
Thank you for the information. I was not aware that a nationally accredited pharmacist can provide such a worthwhile community service. It has also been brought to my attention that some pharmacies have nurses on staff to give a variety of vaccines directly to individuals.

I urge patients to discuss any possible immunization with his or her primary care physician. Regardless of which medical professional gives the injection, there are some instances when it is not recommended. For instance, patients with an egg allergy, a compromised immune system or the use of certain medications that suppress the immune system are often not candidates for vaccinations.

Once Zostavax is reconstituted, the window of opportunity for immunization is only 30 minutes. Should the doctor be running late, if the patient is caught in traffic between the pharmacy and the physician’s office, or any delay occurs and more than 30 minutes has elapsed, this $200 drug must be discarded. In many instances this is not the doctor’s fault, nor is it that of the patient. Accidents happen, but this could be a very costly one.

While the price of the shingles vaccine isn’t recognized by Medicare and might become the responsibility of the recipient, a pharmacy can charge Medicare $20 for the actual injection. This provides an incentive for the pharmacy to offer the service, frees up the doctor’s office, and provides the patient with prompt service. As you stated, Medicare part D (Medicare drug insurance) may cover part or most of the vaccination cost. This is especially helpful to those on limited incomes but are at high risk for contracting shingles.

I was unaware that so many states allowed pharmacists to provide immunizations. Only Maine, New York and West Virginia do not allow this. New York, however, is currently trying to get legislation through that would give pharmacists this ability following proper accreditation. Most supporters point out that seniors are more likely to receive flu and pneumonia vaccinations if they don’t have to go to their physician’s offices. This, in many instances, can save lives by preventing illness in those most susceptible to serious infection.

Thank you for writing. I am glad to know that there are many more sources available for vaccinations.

Readers, if this is something you are interested in, ask your local pharmacist if he or she is accredited and if not, if they know of a pharmacist who is. This can save you both money and time.