Electronic Medical Record Utilization and Medicare Considerations for RSV Vaccines


Electronic health record utilization and financial considerations for RSV vaccines in adults are overviewed by Drs Madison and Welch.

Ryan Haumschild, PharmD, MS, MBA: One thing you and I resonate with, Dr Madison, is our love of technology. How do we leverage technology for the benefit of our patients and make it easier for us as providers, and pharmacists, to provide great care to our patients? One area we’ve created a lot of movement in is electronic health records [EHRs]. And the way we’re storing patients, whether it’s in the hospital systems, clinics, or pharmacies, we can identify eligible patients for treatments. Within that context, we want to think about it regarding the RSV [respiratory syncytial virus] vaccine. How can we leverage EHRs to identify eligible patients for the RSV vaccine? How do we include that information in our workflows to make sure we’re vaccinating these patients and not just identifying them?

Christina Madison, PharmD, FCCP, AAHIVP: You asked me a whole bunch, so let me start from the beginning. First, I want to plug the use of state immunization registries; they’re extraordinarily helpful. When you have an infrastructure in your electronic medical record [EMR], there’s an interface that you can get. I’m not going to go into the details of the interface, but you can ask for this interface so it automatically enters into the system. When you provide vaccination, it will automatically be sent to your state registry. That way, if the patient goes somewhere else, it can be easily accessed by another health care professional, which is fantastic. All of us at the pharmacy have been doing this for a while. You remember when everybody was coming in for their pneumococcal vaccine. They’d come every year, we were like, “Did you get it before?” All these people had all unnecessary doses. We definitely want to avoid that. And we do that by utilizing our EMR.

When we look at the provisions from the federal government, specifically around the Affordable Care Act and the provisions put in place around requirements for EMRs and the collection of specific demographic information, that helps us when we look for some of these key points to highlight when vaccination may be indicated. I want to mention that there are requirements to add SOGI data, which is sexual orientation and gender identity, which will help our LGTBQ brothers and sisters as well as we think about who may be eligible due to health challenges and disparities in historically marginalized populations.

The more data we put into our system, with the ability to integrate with things like our state registries,…will help with workflow. When we think about workflow, what are we trying to prevent? We’re trying to prevent our pharmacy colleagues, as well as our health care, physician, and nurse colleagues, from getting burned out from all this. Going back to this whole thought process around vaccine fatigue, this is 1 other thing I’m adding to your plate. How do I help with that? By seamlessly integrating this into the process you’re already doing. If you’re already incorporating vaccination assessments into your regular routine care, this shouldn’t be an additional add. It should be nothing but a benefit. Everything else is gravy at this point.

Ryan Haumschild, PharmD, MS, MBA: Because I’m from the South, I love that “everything else is gravy” term. You gave a great overview. That’s how we set ourselves up to be successful and utilize those registries so we can keep track of patients, making sure we understand that they receive it outside our facility and inside our pharmacy, so we can better track them.

I’ve got another question for you. It’s 1 thing to implement EHRs to identify eligible patients, but at the end of the day it’s got to get covered from a payer perspective. Knowing that we’re talking about older adults, Medicare is going to play a huge role. How should Medicare handle the coverage of RSV vaccines for adults? Should they do it under Part B or Part D? How would this coverage impact the use of RSV vaccines in certain patients?

Christina Madison, PharmD, FCCP, AAHIVP: This is an important point because it doesn’t work unless you can get it in their arm. You can do all the planning you want, but if the patient doesn’t get the vaccine, all those good intentions are a waste. How do we get this paid for? I was honored to participate last year in a Senate hearing on aging. We talked about some of the impacts of having high prescription drug costs and not capping things like insulin. Another big thing we talked about is routinely recommended vaccinations for older adults, which was part of the Inflation Reduction Act. One of the provisions in that is capping health care–related costs for older adults.

Which payer would be best? Honestly, Medicare Part D has done its job; it has done a lot. But this is a medical benefit when you think about it. When something comes from the medical benefit side, it gives more options for you to pay for it in the pharmacy setting but also in the primary care setting. For somebody who practices in a primary care clinic and knows the barriers why a lot of our primary care providers don’t offer in-house vaccination services, it’s because they don’t feel they’re going to get paid. How do we implement vaccination coverage? By covering it and making sure it’s no cost to the individual providing the vaccination, but then also that it’s no cost to the patient. Some provisions are going to be coming out, and we need to revisit it. It’s vaccine specific, but it should be stated as routinely recommended vaccinations for older adults, and I’m hoping to push legislation forward.

Ryan Haumschild, PharmD, MS, MBA: We’ve talked about payer coverage, but a lot of these new vaccines need to be evaluated and put on formulary. A lot of these payers and providers will do that work. But when we’re looking specifically at pharmacies and providers, we sometimes look at cost-effectiveness. We look at efficacy and safety as we make that consideration. Dr Welch, when you’re thinking about formulary inclusion for these vaccines, what’s needed to incorporate them on the pharmacy formularies? How would early activation of coverage from a payer impact clinical practice?

Adam C. Welch, PharmD, MBA, FAPhA: Early activation of coverage would mean you need to make a decision prior to the MMWR [Morbidity Mortality Weekly Report] publication of the ACIP [Advisory Committee on Immunization Practices] recommendations. Any information to be informed in making that decision is already out there. The phase 3 trials are published in the New England Journal of Medicine. The economic analyses done by the manufacturer and the CDC [Centers for Disease Control and Prevention] were presented at the February 2023 ACIP meeting. Payers can access this information and have all the tools they need to make the decisions about putting these on formulary. I’ve been assured that vaccines will be available from a manufacturing side for the providers once the recommendations come out this summer. All the pieces are there. We just need the providers, payers, and manufacturers—everyone part of this immunization neighborhood—to come together and be ready to act when the time is right, which is this first RSV season coming up.

Ryan Haumschild, PharmD, MS, MBA: I’m hoping we can get the right information out there so there’s a timely implementation of this vaccine. It’s going to benefit all of us.

Transcript edited for clarity.

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