Pharmacists Can Help Patients Access RSV Vaccines

May 2023 marked the approval of the first 2 respiratory syncytial virus (RSV) vaccines for adults 60 years and older: Abrysvo (Pfizer Inc) and Arexvy (GSK).¹ On May 31, 2024, the FDA approved mRNA-1345 (mRESVIA; Moderna) for the protection of adults 0 years and older against lower respiratory tract disease caused by RSV.²

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On June 26, 2024, the CDC updated their RSV recommendations for older adults. Instead of shared clinical decision-making, the CDC now recommends everyone 75 years and older receive 1 RSV vaccine. Individuals 60 to 74 years of age with certain medical conditions, such as cardiovascular disease, or those who reside in a long-term care facility should also receive 1 RSV vaccine. These recommendations do not apply to patients who have already received an RSV vaccine.³ This was also the first time vaccines were available for RSV, COVID-19, and influenza during this respiratory virus season. However, there were obstacles with the initial rollout of RSV vaccines, limiting some patients’ access. As immunizers and educators, pharmacists can help patients access RSV vaccines (Figure).^4-10

Obstacles to RSV Vaccine Access

In older adults, RSV causes approximately 60,000 to 160,000 hospitalizations and an estimated 6000 to 10,000 deaths each year.¹¹ Therefore, vaccination is critical in this population. When the RSV vaccines first became available, there were insurance coverage issues as glitches were being fixed.

Under Medicare Part D, RSV vaccines are covered for patients.⁴ Medicare Part B covers other vaccines, such as COVID-19, influenza, pneumococcal, and hepatitis B immunizations.⁴ This may cause issues for patients who do not have Medicare Part D coverage. The out-of-pocket cost of Arexvy is $280 and Abrysvo’s is $295, which could be an obstacle for patients without health insurance.¹²

Although there currently are no RSV vaccine shortages for older adults, it is important for pharmacies to order an adequate supply to ensure patients have access, especially before RSV season begins. If shortages occur for older adults, the following conditions and populations should be prioritized⁵:

• Individuals who are immunocompromised
• Individuals with diabetes
• Individuals with cardiovascular diseases
• Individuals with renal dysfunction
• Individuals with hepatic conditions
• Individuals with hematologic disorders
• Individuals with neuromuscular or neurologic conditions
• Individuals with pulmonary diseases
• Residents in long-term care facilities

Enhancing RSV Vaccine Access

As of May 11, 2024, approximately 24% of US adults 60 years and older had received an RSV vaccine.¹³ Improving RSV vaccine rates can enhance community coverage for the upcoming season. Currently, the CDC recommends that patients receive 1 RSV vaccine, which should provide coverage for at least 2 seasons.¹¹ Additional doses are not currently recommended. Vaccination is recommended during the summer and early fall to prepare for the RSV season.⁵

Insurance companies and Medicare should cover RSV vaccines that include the new CDC recommendations.⁶ However, a transition period may be needed to update the information, including the new RSV vaccine mRESVIA. Community pharmacists can check to make sure their pharmacy is considered an in-network provider. Additionally, pharmacists can assist patients with locating Abrysvo and Arexvy at local pharmacies through the manufacturer vaccine finder tools.^7,8 Pharmacists can play a critical role in educating older adults about the importance of RSV vaccination.

Blair Green Thielemier, PharmD, founder of Pharmapreneur Academy, discussed RSV vaccine obstacles and strategies to enhance access through Medicaid in an email interview with Pharmacy Times. Thielemier said recognition of pharmacists as providers is another obstacle.

“Some of the main access issues I have seen as a consultant pharmacist in the state of Arkansas are with Medicaid not recognizing the pharmacist as the provider of the RSV vaccine,” Thielemier said. “We are taking the appropriate steps to credential with Arkansas Medicaid. However, the lack of federal provider status leaves pharmacists in a gray area with [the CMS]. Hopefully this will resolve many of the reimbursement challenges pharmacists face as we transition to a more clinically integrated health care system.”

Coadministration of the RSV vaccine with other immunizations may also prevent missed opportunities.^5,9 It is important to counsel patients that they may experience more adverse effects, such as injection site soreness and fever. Limited evidence suggests that administering RSV and influenza vaccines on the same day may not generate as strong of an immune response, but future research is needed in this area to determine whether this is clinically significant.⁵

References

1. Healthcare providers: RSV vaccination for adults 60 years of age and over. CDC. Updated March 1, 2024. Accessed March 18, 2024. https://www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults.html

2. Gallagher A. FDA approves mRNA-1345 for protection against lower respiratory tract disease caused by RSV. Pharmacy Times. May 31, 2024. Accessed June 5, 2024. https://www.pharmacytimes.com/view/fda-approves-mrna-1345-for-protection-of-lower-respiratory-tract-disease-caused-by-rsv

3. CDC Updates RSV Vaccination Recommendation for Adults. CDC. News release. June 26, 2024. Accessed July 1, 2024. https://www.cdc.gov/media/releases/2024/s-0626-vaccination-adults.html

4. Respiratory syncytial virus (RSV) shot. Medicare.gov. Accessed March 21, 2024. https://www.medicare.gov/coverage/respiratory-syncytial-virus-rsv-shot

5. Frequently asked questions about RSV vaccine for adults. CDC. Updated March 1, 2024. Accessed March 28, 2024. https://www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults-faqs.html

6. ACIP shared clinical decision-making recommendations. CDC. Updated September 29, 2023. Accessed March 26, 2024. https://www.cdc.gov/vaccines/acip/acip-scdm-faqs.html

7. Find Pfizer’s RSV vaccine near you. Abrysvo. Accessed March 29, 2024. https://www.abrysvo.com/find-a-vaccine

8. Find Arexvy: locate and schedule your vaccine appointment for Arexvy. Arexvy. Accessed March 29, 2024. https://arexvy.com/get-arexvy/find-arexvy/

9. Black C. RSV vaccination implementation update. CDC. February 29, 2024. Accessed March 26, 2024. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2024-02-28-29/04-RSV-Adults-Black-508.pdf

10. Find a program. Pfizer RxPathways. Accessed March 28, 2024. https://www.pfizerrxpathways.com/find-program

11. Melgar M, Britton A, Roper LE, et al. Use of respiratory syncytial virus vaccines in older adults: recommendations of the Advisory Committee on Immunization Practices — United States, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(29):793-801. doi:10.15585/mmwr.mm7229a4

12. CDC vaccine price list. CDC. Updated April 2, 2024. Accessed April 30, 2024. https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html

13. Vaccination trends—adults. CDC. April 26, 2024. Accessed March 26, 2024. https://www.cdc.gov/respiratory-viruses/data-research/dashboard/vaccination-trends-adults.html