A Silver Spring woman sought the respiratory syncytial virus vaccine to protect her baby. It became a test.
Today we bring you the story of a patient seeking the RSV vaccine. And she explains how her journey of setbacks shows why it is so difficult to obtain critical medicines recommended by federal regulators in the United States.
hannah fegley A woman in Silver Spring, Maryland, said she spent seven hours on the phone last month (she was eight months pregnant) with her insurance company, pharmacy benefits representative and six pharmacies trying to get information. Pfizer’s new RSV vaccine “Abrysvo”.
RS virus infection to 2 percent How many babies are admitted to the hospital each year because their tiny airways can’t tolerate the inflammation? Most recover with supportive care, but 300 children Children under the age of five die each year, with the majority under the age of one. Infecting her with RSV during infancy can cause her to have asthma for the rest of her life.
Fegley said two of her friends witnessed her baby being taken to the intensive care unit last year. What is bad for RSV. So she was eager to get that shot. She has a 4-year-old preschooler who she says “brings all the viruses home to her.”
one of KFF Health News‘The signature project is tthis month’s billIn , readers and listeners send us stories about how the U.S. health care system isn’t working. In many cases, the problems they face are directly related to holes in government policy. Fegley’s story illustrates how regulatory recommendations are impacting a fragmented health care system and leaving patients at a loss.
Pfizer vaccine (list price: approx.) 300 dollars), which provides immunity to the fetus through the mother. As an alternative, Advisory Committee on Immunization Practices Also recommended AstraZeneca‘s Beyfortus (about 500 dollars), a monoclonal antibody against the virus given to infants after birth. Fegley’s obstetrician did not have the vaccine. So she predicted (correctly) that many pediatricians wouldn’t stock Bayfortus and gave Mr. Fegley a prescription to get it at the pharmacy.
Pharmacies usually stock the RSV vaccine because the CDC recommends it for people over 60. Scientists and public health officials agree that the bigger the market, the better. Obvious use is infants. There are two RSV vaccines approved for older adults in the United States. One is the Pfizer vaccine, which is also approved for pregnant women. glaxosmithkline A shot that isn’t.
Fegley Insurance Company uses: CVS-Caremark As a pharmacy benefits manager, of course, cvs pharmacy. (both It’s a part of CVS Health Corporation.) Then she noticed that CVS only stocked the GSK vaccine.
(Is your head still spinning? So was she. And she’s a social worker with a background in health care and whose husband is a doctor. “They say we have a choice, but… , that’s actually not the case,” she said.)
After a phone complaint, a Caremark representative gave Fegley a “right of first refusal” to allow her to try another pharmacy. She called them and many said the Pfizer vaccine would only be given to people 60 and older.
“We are currently completing the final steps necessary to offer a maternal RSV vaccine and hope to have it available in pharmacies soon,” he said. matt blanchettCVS Health spokesperson Caremark and pharmacy representatives. “Patients should check with their insurance company to see if the vaccine is covered by their individual plan.”
A small pharmacy called to say they had medication for Fegley, but when she checked her insurance at the counter, she was denied the drug.She filled out forms to take both exams costco and walgreens. was denied.
She didn’t want to pay more than $300 for out-of-pocket shots because she knew that under Obamacare, most insurance companies must cover all ACIP-recommended vaccines for free. So why is it so difficult to obtain a vaccine that the FDA and CDC claim can save infants’ lives? Let’s count the ways.
- One: The Affordable Care Act gives insurers more than a year after a new vaccine receives ACIP’s stamp of approval to begin covering it.
- two: To keep costs down, pharmacies try to contract with just one drug company to get deals on similar products. GSK It didn’t end The company has applied to the FDA for approval to vaccinate pregnant women.
- three: Many pharmacies do not like to inject pregnant women for fear of liability.
- four: Both obstetricians (in the case of the Pfizer vaccine) and pediatricians (in the case of the monoclonal antibody) are struggling to stock these expensive drugs, especially as insurance reimbursement is uncertain.
“Cost is a big issue,” he says. Steven Abelowitz of coastal children, Large group practice in California. “For us, this was a tough and risky decision. We spent millions of dollars ordering batches and we don’t know if we will be reimbursed,” he said. “Small clinics don’t have the funds.”
There’s a happy ending: Earlier this month, a Caremark representative left Fegley a voicemail telling her she had priority access to receive the Pfizer vaccine at Costco. $105 At your own expense. If she wants it free, she should contact her husband’s employer, the representative added.
Although she felt some resentment, she says she paid for the shoot.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of our core operating programs. KFF — An independent source of health policy research, polling, and journalism.
Federal funding bill on hold after Republican standoff over Washington DC abortion rider
House Republican leadership postponed the vote Yesterday, the Post reported that a group of moderate Republicans spoke out about a major federal spending bill after they opposed D.C.’s abortion-related restrictions included in the massive bill. megan flynn and Marianna Sotomayor report.
detail: Eight Republican senators expressed concern about a provision that would block D.C. from enforcing a 2014 law that prohibits discrimination based on reproductive health choices. The narrow Republican majority was a large enough bloc to threaten the entire financial services spending bill, especially given the absentees.
- Moderates wanted this clause removed from the bill. California lawmakers say this was proposed as a separate amendment. John S. Duartewas one of the Republicans who opposed D.C. Rider.
Factors contributing to abortion: The backlash surprised D.C. officials, who are not used to seeing Republicans defending the deep blue city. But some moderates have drawn a red line at attempts to block enforcement of the district’s reproductive health anti-discrimination laws, especially as abortion makes Republicans increasingly vulnerable in key battleground states and states. I subtracted. Tuesday’s election Megan and Marianna point out that they provide further evidence.
Two House Republican leaders are applying pressure. Department of Veterans Affairs Get the latest information on the agency’s efforts to end dependence on China for critical medical supplies.
in letter I sent it to the VA Secretary yesterday. dennis mcdonoughLawmakers noted that the coronavirus pandemic has exposed the national security and public health risks of the United States’ dependence on global supply chains for life-saving equipment. They are seeking information by November 29 on the agency’s plans to address these concerns.
- The letter was signed by House of Representatives China Select Committee chairman mike gallagher (Republican, Wisconsin) House Veterans Committee chairman mike bost (R-Ill.).
- A VA spokeswoman confirmed the agency had received the letter and said it was working to answer lawmakers’ questions.
CDC data shows vaccine exemptions for kindergartners at record level
The overall proportion of kindergarten children exempted from vaccination is 2.6 percent During the 2021-2022 academic year 3 percent From 2022 to 2023, Highest rate ever reported Post newspaper in the US Lena H. Sun reporting, quotation federal data It was released yesterday.
This equates to over 100,000 children The parents sought to exempt their child from at least one vaccination, including measles, whooping cough and polio vaccines, which are legally required for school attendance in all states and the District of Columbia.Non-medical reasons account for a large proportion 90 percent Number of exemptions reported.
Overall picture: The report from Centers for Disease Control and Prevention This highlights the impact the coronavirus pandemic is having on routine immunization rates and its lingering impact on school-age children. Increased risk of highly contagious diseases.
But even before the pandemicmore parents Increased number of states Refusal of necessary vaccinations for children for the following reasons: vaccine avoidance and anti-vaccine sentiment. The public health emergency has exacerbated these concerns, Lena wrote, with controversy and politicization surrounding coronavirus vaccines and mandatory vaccinations in schools.
- Abortion rights advocates in Indiana filed a lawsuit Yesterday I asked the court for a preliminary injunction. Continuing constitutional challenges to the process have blocked the state from enforcing its near-total ban on the process. indianapolis star‘s Kayla Dwyer I will report it.
- 1.6 million people participated in the first week of recruitment enrolled in health insurance Afforable Care Act MarketplaceThat includes more than 300,000 new customers, White House officials said.
- Kaiser Permanente Employees voted for ratification New 4-year contract with industry giant, The union made the announcement yesterday after months of tense negotiations. Largest medical strike in the history of the nation.
- Puerto Rico health officials declared an influenza epidemic yesterday. The U.S. territory has reported at least 25,900 cases since July, with 42 deaths and more than 900 hospitalizations on the island of 3.2 million people. Associated Press.
“We believe voters — Democrats, independents, and a growing number of Republicans — will support these candidates. [irrespective] It is people in their political parties who are defending and strengthening our democracy and restoring the freedoms that politicians have taken from us. ”
— Rep. Greg Landsman (D-Ohio), who represents a purple district, said after Tuesday’s election.
Despite Ohio victory, marijuana legalization faces tough prospects in red states (By Fenit Nirapir and David Obare | The Washington Post)