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  • 1.  Shingles and Men ACWY Vaccine Barriers

    Posted 10-21-2025 12:52

    Hi all,

    The clinic I work at has limited capacity on the vaccines they can carry. Shingles and Men ACWY are the two main vaccines that the clinic's finance department claims are "cost prohibitive" to carry and administer.

    We have several patients <50 y/o who are candidates for the Shingles vaccine according to the guidelines, but pharmacies are turning them away because the insurance providers will not cover the vaccine until the patient is >50. We also have patients of all ages with the same issue for Men ACWY q5-year boosters. The clinic providers and I have tried to send prescriptions with the associated diagnosis code for HIV with no luck.

    Our only option right now is to recommend that patients visit a local health department. This can be inconvenient to the patients.

    Has anyone had a similar issue? Any suggestions/resolutions to share?

    Thanks,



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    Kristen Lindauer, PharmD, BCPS, AAHIVP
    Fallon, NV
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  • 2.  RE: Shingles and Men ACWY Vaccine Barriers

    Posted 10-21-2025 18:01

    Our clinic was in a similar position. We were losing money on vaccines and not carrying some that our patients needed. We recently moved to a company called VaxCare. They purchase and stock the vaccines in our clinic, and provide a hardware/software system that scans a QR code on each vaccine dose and does benefit investigation in real time. If we offer a vaccine we can tell the patient if there would be any cost to them, and if there is a copay they can decide. It's a very slick system though there a few bugs/growing pains that are being addressed. Their system integrates with our EMR, charts the vaccine, and reports it to the state vaccine database. We have no financial obligation and they pay us the administration fee for each vaccine. Their system correctly identified eligibility for Shingrix for pts with HIV who are less than 50 y o. We are now able to offer vaccines we could not in the past due to $$ - including HPV, meningococcal, and RSV. I don't know if their service is available to any clinic in any location but they are a godsend for us. Their mission per their website: "Vaxcare - VaxCare Prevents Your Clinic from Losing 8-15% of its Bottom Line. Our All-Inclusive System Provides Vaccines At No Cost While Reducing Extra Clinical Work. No More Lost Inventory. Auto-Ordering & Delivery. Automated Replenishment. No Cost Vaccine Inventory."



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    Peter Shalit
    Seattle WA
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    Original Message


  • 3.  RE: Shingles and Men ACWY Vaccine Barriers

    Posted 10-21-2025 23:45

    We have an in house pharmacy, so we moved most high cost vaccines to the pharmacy. Under ACA and Inflation Reduction Act of late 2023 most insurances including Medicaid are obligated to cover vaccines ACIP recommended vaccines without cost sharing (this includes Shingrix for PLWH and also Gardasil up to age 45). It is ideal to have a pharmacist immunizer, however, most plans (here in New York state) cover pharmacy dispensed and medically administered vaccines. It has saved us over $100k/year for pneumococcal vaccines alone and has also allowed us to offer mpox vaccine and keep covid vaccines in stock. Collaborating with a local retail pharmacy would likely also work. There is some patient attrition with the extra steps but it does allow us to maintain access. As an exception we cover most high cost vaccines for patients with ADAP (Ryan White insurance only) to also ensure access. Basically, we simply are no longer subsidizing insurance plans that don't reimburse us. If pharmacy is still getting rejections, a plan may require medical billing, but more likely they are in violation of Inflation Reduction Act and should be reported to CMS.



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    Elsbet Servay FNP-BC, AAHIVM, ACHPN

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    Original Message


  • 4.  RE: Shingles and Men ACWY Vaccine Barriers

    Posted 11-02-2025 12:13

    I've seen some good ideas that have already been shared. You've mentioned that your patients need to visit a local health department which you said could be inconvenient to the patients. An idea is to maybe ask the heath department to come to your clinic to give vaccines? We've found that our public health partners in Iowa have been wonderful collaborators! They have helped immensely with labs and referrals for our TelePrEP program, and their DIS workers sometimes even accompany patients to their first appointment or help to get partners tested. 

    It takes a village!

    Dena Dillon, PharmD, AAHIVP 

    Clinical Pharmacy Specialist, Virology UI Healthcare 

    Partners PrEP Coordinator 

    Consultant/mentor, MATEC



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    Dena Behm Dillon, PharmD, AAHIVP
    Clinical Pharmacy Specialist, University of Iowa HealthCare
    Partners PrEP Coordinator, Iowa TelePrEP
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    Original Message


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