Health

The Frustrating Journey to Get an Important Vaccine

courtesy of kffhealthnews.org

Why is it so Hard to Access the RSV Vaccine in the US?

A patient's frustrating experience highlights the difficulties in obtaining an important medicine recommended by federal regulators.

Hannah Fegley of Silver Spring, Md., spent hours on the phone with insurers, pharmacy benefit managers, and pharmacies trying to get Pfizer's new RSV shot, called Abrysvo. This vaccine is crucial in preventing respiratory syncytial virus, which puts up to 2 percent of babies in the hospital each year and can lead to serious complications.

A Deadly Virus

RSV is a dangerous virus that can cause hospitalization and even death in young children. A bad case of RSV in infancy can also lead to a lifetime of asthma.

Fegley, who has a 4-year-old in preschool, was eager to get the shot due to her friends' experiences with their babies landing in intensive care last year. However, navigating the fragmented health system proved to be a challenge.

A Fragmented Health System

Fegley's story demonstrates how regulators' recommendations trickle down into a fragmented health system, leaving patients in difficult situations. The vaccine recommended by federal regulators was not readily available, leaving Fegley to make countless calls and face numerous obstacles.

The Issue of Availability and Choice

Fegley's obstetrician did not carry the vaccine, so she was given a prescription to obtain it at a pharmacy. However, many pediatricians did not stock the recommended vaccine. Pharmacies typically stock RSV vaccines for older Americans, even though the more obvious use is in infants. This lack of availability and choice created confusion and frustration for Fegley.

The Cost Barrier

The cost of the RSV vaccine was a major obstacle for Fegley. With a list price of about $300, she did not want to pay out-of-pocket when most insurers are required to cover all ACIP-recommended vaccines free of charge under Obamacare. The high cost of the vaccine posed challenges for both patients and healthcare providers.

A Happy-ish Ending

After much back-and-forth, Fegley was finally able to obtain the Pfizer vaccine at Costco for $105 out of pocket. While she ultimately paid for the shot, her journey highlights the difficulties patients face in accessing important vaccines.

Overall, Fegley's story sheds light on the challenges patients encounter in navigating the US healthcare system and the need for improved access to life-saving vaccines.

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