{"id":1974,"date":"2023-11-13T14:32:56","date_gmt":"2023-11-13T14:32:56","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=1974"},"modified":"2023-11-13T14:32:56","modified_gmt":"2023-11-13T14:32:56","slug":"what-one-expectant-moms-effort-to-get-an-rsv-shot-says-about-health-policy","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=1974","title":{"rendered":"What One Expectant Mom\u2019s Effort To Get an RSV Shot Says About Health Policy"},"content":{"rendered":"
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Today we bring you the story of a patient seeking the RSV vaccine \u2014 and how her frustrating journey illustrates why it can be so hard in the United States to get an important medicine recommended by federal regulators.<\/p>\n

Hannah Fegley<\/strong> of Silver Spring, Md., says she spent seven hours on the phone last month \u2014 the eighth month of her pregnancy \u2014 with insurers, pharmacy benefit managers and half a dozen pharmacies trying to obtain Pfizer\u2019s new RSV shot, called Abrysvo<\/strong>.<\/p>\n

Respiratory syncytial virus puts up to <\/u>2 percent<\/u><\/strong><\/a> of babies in the hospital each year because their tiny airways don\u2019t tolerate the inflammation. While most recover with supportive care, as many as 300 kids<\/strong> under 5 years old die each year and the majority of them are under 1. A bad case of RSV in infancy can mean a lifetime of asthma. \u00a0<\/p>\n

Fegley says two of her friends saw their babies land in intensive care last year, a bad one for RSV<\/u><\/a>. So she was eager to get the shot; she has a 4-year-old in preschool who, she says, \u201cbrings home every virus.\u201d\u00a0<\/p>\n

One of KFF Health News<\/strong>\u2019 signature projects is the Bill of the Month<\/u><\/a>, where readers and listeners send us stories about how the U.S. health system is failing them. Often, the problems they encounter connect directly to holes in government policy. Fegley\u2019s story shows how regulators\u2019 recommendations trickle down into a fragmented health system \u2014 leaving patients in the lurch. \u00a0\u00a0<\/p>\n

The Pfizer vaccine (list price: about $300<\/strong>), confers immunity to the fetus through the mother. As an alternative, the Advisory Committee on Immunization Practices <\/strong>also recommended AstraZeneca<\/strong>\u2019s Beyfortus<\/strong> (about $500<\/strong>), a monoclonal antibody against the virus to administer to babies after birth. Fegley\u2019s obstetrician didn\u2019t carry the vaccine. So she gave Fegley a prescription to get it at a pharmacy, predicting (correctly) that many pediatricians wouldn\u2019t stock Beyfortus.<\/p>\n

Pharmacies typically stock RSV vaccines because the CDC also recommends them for people over 60 \u2014 a large and lucrative market, even though scientists and public health authorities agree the more<\/strong> obvious use is in infants<\/u><\/strong><\/a>.<\/strong> There are two different RSV vaccines approved for older Americans: the Pfizer shot, which is also approved for pregnant women, and a GlaxoSmithKline <\/strong>shot that is not.\u00a0<\/p>\n

Fegley\u2019s insurer uses CVS-Caremark<\/strong> as its pharmacy benefits manager, which of course uses CVS Pharmacy<\/strong>. (Both are part<\/u><\/a> of CVS Health Corp<\/strong>.) And CVS, she discovered, only stocks the GSK vaccine.\u00a0<\/p>\n

(Is your head spinning yet? Hers was. And she is health-care literate \u2014 \u00a0a social worker whose husband is a doctor. \u201cWe\u2019re told we have choice, but we really do not,\u201d she said.)\u00a0<\/p>\n

After a phone complaint, a Caremark representative granted Fegley an \u201coverride\u201d allowing her to try other pharmacies. She called them, but many said they\u2019d only give the Pfizer shot to people 60 and over.<\/p>\n

\u201cWe\u2019re currently completing the final steps needed to offer the maternal RSV vaccine and hope to make it available at our pharmacies soon,\u201d said Matt Blanchette<\/strong>, a CVS Health spokesman representing Caremark and the pharmacy. \u201cPatients should check with their insurer to confirm if the vaccine is covered by their individual plan.\u201d<\/p>\n

One smaller pharmacy said by phone it had a dose for Fegley, but when they checked her insurance at the counter, it was denied. She filled out forms to get a shot at both Costco<\/strong> and Walgreens<\/strong>. Denied.\u00a0<\/p>\n

She didn\u2019t want to pay $300 or more for the shot out-of-pocket because she knew that under Obamacare, most insurers must cover all ACIP-recommended vaccines free of charge. So how can it be so hard to obtain a shot that the FDA and CDC say can save babies\u2019 lives? Let us count the ways.<\/strong><\/p>\n