Re: which vaccines giving in office to over 5

[Guest guest]

RE no vaccines in office

My area (east of Pittsburgh, PA) hasn't moved to getting vaccines in pharmacies yet, but was interested in others who have.

We have the dubious "pleasure" of now having PA/NPs who are working "semiautonomously" with a doc from SOMEWHERE giving support on basic dx/rx from elsewhere, and am not sure if pts will be able to "walk in" and get dT booster without seeing one of these people.

I've been seeing kids over 5, so no early childhood immunizations -- do a little DPA work, and send them to health dept although am not sure if any have actually gotten their shots (only 1 family so far).

Chose not to give ANY flu shots since opening Dec 2004 as unreliable delivery, but our area ran out of flu shots this year, and despite now being "plentiful," somehow noone is promoting. Plan to keep a list of pts end of summer this coming year, as have a source to order a short supply, and will precert to be sure we get paid up-front for those who are eligible. Had about 50 pts call for them.

Pneumovax I keep stocked -- fair Medicare reimbursement on this.

Hep B still keep a couple on hand, I think.

Tdap haven't bothered, as dT is still available, and I've been wanting to keep on hand for elderly, as they often come in after wound to my office. Tdap isn't certified for over 64, or under 11, so see no reason for me to have this on hand and have to buy 5-10 doses at a time.

Menactra last summer I ordered in the mandatory "5 at a time" and we checked all insurances, ordering ONLY when had 5 to give. Remember there was shortage, but now is advised for the 11-12 year old checkups, or prior to college age if they hadn't gotten it. Except for the upfront cost, reimbursement's not really that bad.

I also have PPD at office, low cost, but reimbursement would only cover 1 shot, and must dispose after 30 days, so my usual reimbursement of under $4/shot doesn't really pay. However, cost of exam will make it work out.

Are people giving the Gardisil with people paying up-front, and what about the Shingles vaccine? Thought that coverage was very limited right now and $150+ per vaccine seems too steep for me to keep in inventory so if pt wants it, considering "purchase ahead" and get for them. Other thoughts??

Dr Matt Levin

FP, solo since Dec 2004

Pittsburgh east suburbs, PA

PATIENT CHECK OUT SHEET> > > > Here it is! I simply write my instructions like exrecise 3 x week,> do yoga. Take your BP, meds etc... then I circle which category> they are in (uncontrolled chronic, controlled chronic, no issues)> and I circle FU interval and explain why. I explain my goal for > everyone is to advance to the no issues category. I review HCM> deficits before they leave at each visit and I have the phone #> displayed for the county healthdept for vaccines (since I do not> given them in my office) and it has been an incredible asset to> our communication. I have a separate FU sheet for DM and Asthma> and I'll forward them next f yall want to check themout. Oh, and I > print these up on colorful fun paper (like with balloons around the> perimeter) and it sort of looks like an invitation to a party but it> is really just an invite to their next appt. I fit 2 on each page when> I copy them.> > Pamela> > _____________________________________> > Special Instructions:> > Follow Up Appointment: _____________________ or please call > > ___ Uncontrolled chronic issues 1 wk 2 wk 3 wk 4 wk> ___ Controlled chronic issues 2 mo 3 mo 4 mo 6 mo> ___ No issues seeya in a year !> > Health Care Maintenance: > complete physical pap mammogram dental exam vision exam> labs cholesterol prostate thyroid other___________________> colonoscopy (more fun than it sounds) > immunizations (Tetanus, Tdap, Influenza, Pnemoccocal, Hep A, Hep B> Meningococcal, Varicella, MMR, ____________ ) 682-4041 LCPHD> > Please ensure you have enough medications until your next visit>

[Guest guest]

A pharmacist friend told me that medicare part b would pay for the shingles vaccine.

PATIENT CHECK OUT SHEET> > > > Here it is! I simply write my instructions like exrecise 3 x week,> do yoga. Take your BP, meds etc... then I circle which category> they are in (uncontrolled chronic, controlled chronic, no issues)> and I circle FU interval and explain why. I explain my goal for > everyone is to advance to the no issues category. I review HCM> deficits before they leave at each visit and I have the phone #> displayed for the county healthdept for vaccines (since I do not> given them in my office) and it has been an incredible asset to> our communication. I have a separate FU sheet for DM and Asthma> and I'll forward them next f yall want to check themout. Oh, and I > print these up on colorful fun paper (like with balloons around the> perimeter) and it sort of looks like an invitation to a party but it> is really just an invite to their next appt. I fit 2 on each page when> I copy them.> > Pamela> > _____________________________________> > Special Instructions:> > Follow Up Appointment: _____________________ or please call > > ___ Uncontrolled chronic issues 1 wk 2 wk 3 wk 4 wk> ___ Controlled chronic issues 2 mo 3 mo 4 mo 6 mo> ___ No issues seeya in a year !> > Health Care Maintenance: > complete physical pap mammogram dental exam vision exam> labs cholesterol prostate thyroid other___________________> colonoscopy (more fun than it sounds) > immunizations (Tetanus, Tdap, Influenza, Pnemoccocal, Hep A, Hep B> Meningococcal, Varicella, MMR, ____________ ) 682-4041 LCPHD> > Please ensure you have enough medications until your next visit>

[Guest guest]

According to the package insert for Tubersol:

" A VIAL OF TUBERCULIN PPD WHICH HAS BEEN ENTERED AND IN USE FOR 30

DAYS SHOULD BE DISCARDED BECAUSE OXIDATION AND

DEGRADATION MAY HAVE REDUCED THE POTENCY. "

As long as you don't open the vial, it will be good until the

expiration date. Once entered/opened, it is only good for 30 days. I

didn't learn about this until recently, too.

Cost of 10 dose vial = about $27.

Reimbursement for 86580 = $8-13.

So you would need to get at least 2-3 uses/vial for it to be worth

it. I look upon it as a necessary cost of doing business, and not as

a money maker.

Seto

South Pasadena, CA

> Dispose of PPD after 30 days? What brand are you using? I think

> mine is good for a year or so.

>

>

[Guest guest]

I have been told that the Shingles vaccines

is actually covered under Medicare Part D and have absolutely no idea on how it

will be reimbursed. I have a couple of people express an interest but advised

them to find out if it will be covered for them and have not heard back.

I have a couple of people interested in Gardasil

who tell me it will be covered. But I am having problems making myself order a

vaccine that will cost me over $150 out of pocket a dose and hope that they

follow through with the vaccine. I imagine the shelf life will be a year or two

so I shouldn’t eat the cost but having my flu vaccine bill come in this

month, I am hesitant. After all, Christmas is coming.

Kathy Saradarian, MD

Branchville, NJ

Solo low-staff practice since

4/03

In practice since 9/90

Practice Partner User since 5/03

[Guest guest]

I have actually given the all of the first of my shipments of Zostavax. It wasn't covered by any Medicare or secondary insurance. My patients all knew the cost and were willing to pay it. I got a bulletin from the local medicare people who said they are paying after the first of the year. I sent out a letter to my patients who were of an age to consider Zostavax and then I ordered the vaccine after I knew I had enough interest. I have also given a whole bunch of Gardasil. I sent a similar letter to those patients and their families. It is covered by everyone now. I make $60 per patient getting vaccinated, this is after my cost for this expensive vaccine. The good thing is that everyone gets a total of 3 doses, you can order a relatively small quantity. (I ordered 6 initially, now I am getting 10). Merck will get it to you in a matter of days. It also has a super long shelf life. So anyway, I give a whole bunch of vaccines at my office and like a lot of other things on this listserve, it kind of depends on your area and patient population. Where I am, people would never go to the health department to get vaccinated. It would be too much red tape and distance and time etc... for them. They would just find another doctor to do their medical care. So some of the things I give I probably break even on the vaccine itself, but it helps me keep business. Other things I probably make a little bit of money on. .

[Guest guest]

Gardasil costs $120. purchased directly through Merck. I am being reimbursed at about 144 for it, plus whatever companies pay for giving the shot. I take care of a number of teenagers and their parents all said they would pay out of pocket if necessary.NI have been told that the Shingles vaccines is actually covered under Medicare Part D and have absolutely no idea on how it will be reimbursed.  I have a couple of people express an interest but advised them to find out if it will be covered for them and have not heard back. I have a couple of people interested in Gardasil who tell me it will be covered.  But I am having problems making myself order a vaccine that will cost me over $150 out of pocket a dose and hope that they follow through with the vaccine.  I imagine the shelf life will be a year or two so I shouldn’t eat the cost but having my flu vaccine bill come in this month, I am hesitant.  After all, Christmas is coming. Kathy Saradarian, MDBranchville, NJSolo low-staff practice since 4/03In practice since 9/90Practice Partner User since 5/03 

[Guest guest]

I just got an eob for a girl who got her first gardasil shot and Cigna is her insurer. They reimbursed $157 for the vaccine and $17.30 for administration. I pay $117 per shot and again, its a series of 3. I don't think its too bad, it just stinks if you have to waste it. I waited until I had someone call and say they wanted it before ordering my first set. It comes in just a couple days. I did the same thing for menactra.

[Guest guest]

On this listserve someone said they had run a list of eligible pt for Gardasil, and sent letters about it. I decided to do similar thing. I see alot of middle age women, and often their daughters. Since the Gardasil can be bought in a vial of 10 doses, takes 3 doses to complete series, only need 3 patients to have,possibly "waste, one dose" The schedule is similar to Hep B, one now, one in a month, one at 6 mo from the first. Can hopefully keep track of these patients for 6 mo. We easily obtained 3 pt who wanted, and ordered the vial. Had them sign up front waiver of benefit. That is if their insurance doesn't pay, that they would, and we listed the cost to them, $145, which is the vaccine cost, and the cost of administering. Brought them in yesterday, all three had their shots, and have others calling of the list to discuss.

As for the flu vaccine, I haven't been able to get for 2 yr, despite ordering. A surprising number of people were a little irritated, that we didn't have. This yr I ordered a small amt, but have mostly used Flumist. When I opened 3 yr ago, Flumist was new, and I took a chance since you could return whole vials unused. It is now my most "popular vaccine". It's approved for age 5y-49, but will have approval for down to 2 yr next season. Altho asthma listed as contra indication, in yrs where we couldn't get Flu vaccine, the local pulmonologist were giving, and rec this, so I did too. Have a form from the company saying, the possible risks' " might cause an asthma attack". Because it has a 1 yr shelf life, and gives immunity in 48 hr, not the 2 wk for the flu vaccine, it can be given much later in the season. It also lasts for a full yr, and provides better immunity in a "mis-match yr". When theres a strain that didn'

t make it into the shot. Supposedly this is from the contribution of the nasal mucosa stimulation. So far this yr, it's being paid for by all the insurances, the last 2 yr, once flu shots weren't available here, with some reluctance the insurances paid. AGain pt sign a waiver saying, I want it, if my insurance doesn't pay, I will.

So thanks to the list that I catch up on when time allows, but I have been able to start providing this ridiculously expensive vaccine, and will actually break even, or perhaps make some money.

Cote

Four Corners Family Medicine

Maple Valley WA

-------------- Original message --------------

Gardasil costs $120. purchased directly through Merck. I am being reimbursed at about 144 for it, plus whatever companies pay for giving the shot. I take care of a number of teenagers and their parents all said they would pay out of pocket if necessary.

N

I have been told that the Shingles vaccines is actually covered under Medicare Part D and have absolutely no idea on how it will be reimbursed.? I have a couple of people express an interest but advised them to find out if it will be covered for them and have not heard back.

?

I have a couple of people interested in Gardasil who tell me it will be covered.? But I am having problems making myself order a vaccine that will cost me over $150 out of pocket a dose and hope that they follow through with the vaccine.? I imagine the shelf life will be a year or two so I shouldn?t eat the cost but having my flu vaccine bill come in this month, I am hesitant.? After all, Christmas is coming.

?

Kathy Saradarian, MD

Branchville, NJ

Solo?low-staff?practice since 4/03

In practice since 9/90

Practice Partner User since 5/03

?