Financial Barriers Chief Among Reasons for Infrequent Use of Herpes Zoster Vaccine
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Why do fewer than 10% of eligible older adults receive the herpes zoster vaccine?
According to a national survey of general internists and family medicine physicians, the primary barriers to immunization uptake are financial—notably the high cost of the vaccine and reimbursement through Medicare Part D instead of the more familiar Part B.
The mail and Internet-based survey asked physicians about their current vaccination practices, knowledge and practice regarding reimbursement for the herpes zoster vaccine, and barriers to vaccination. Responses were obtained from 301 general internists and 297 family medicine physicians, which represented a 72% response rate for both specialties.
The majority (88%) of respondents reported recommending the herpes zoster vaccine to eligible patients, with about half (41%) stating that they strongly recommend it. This is in contrast to the more than 90% of respondents who indicated that they strongly recommend influenza and pneumococcal vaccines. The most common methods for delivering the herpes zoster vaccine (which requires freezer storage) were stocking and administering the vaccine in the office (49%), referring patients to a pharmacy to purchase the vaccine and bring it back to the office for administration (36%), and referring patients to a pharmacy for vaccine administration (33%); more than one third of the physicians (38%) used more than one of these methods.
The three most commonly perceived barriers to the use of herpes zoster vaccine were financial: cost concerns for patients, reimbursement problems for the practice, and the up-front costs of purchasing the vaccine. Of respondents who began administering herpes zoster vaccine in their office, 12% stopped because of cost and reimbursement issues. About half of the physicians (49%) stated that they would be much more likely to administer the vaccine if it were covered under Medicare Part B instead of Part D.
Other barriers cited by respondents included the need to have patients pick up the vaccine at a pharmacy and the need for freezer storage.
[Editor’s Note: Given the results of this survey, pharmacists who include herpes zoster vaccine among the immunization services they offer might consider marketing this option to local primary care providers.]
Ann Intern Med. 2010;152(9):555-60.