Shingles Vaccine Proves Painful - Stringent Rules, High Prices, Limited Access

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I came down with shingles after having a tetnus shot!!! ng .... I'll stick to Ledum instead ...

Shingles Vaccine Proves Painful - Stringent Rules, High Prices, Limited Access

An abstract follows the news item.Vaccination research Goldman concluded:"We estimate universal varicella vaccination has the impact of anadditional 14.6 million (42%) HZ cases among adults aged <50 years duringa 50 year time span at a substantial cost burden of 4.1 billion US dollarsor 80 million US dollars annually utilizing an estimated mean healthcareprovider cost of 280 US dollars per HZ case." (1)As with thimerosal, the MMR, and other injectables, the varicellavaccination is (from a pharma point of view) remarkably iatrogenic. Binstock-Shingles Vaccine Proves PainfulPatients Confront Stringent Rules, High Prices, Limited AccessBy G. BoodmanWashington Post Staff WriterTuesday, September 25, 2007; HE01http://www.washingtonpost.com/wp-dyn/content/article/2007/09/21/AR2007092101818.htmlClara son is the kind of person public health officials had in mindwhen they approved the shingles vaccine last year.At 83, she recently suffered through a painful bout of shingles, areactivation of the dormant virus that causes chickenpox. It was, sherecalls, "quite nasty," an experience she is eager to avoid repeating.With the possibility of a recurrence in mind, her suburban landinternist urged her to get the shot known as Zostavax, which an advisorycommittee to the federal Centers for Disease Control and Prevention hasrecommended for Americans 60 and older.But son's willingness to be immunized evaporated once she discoveredthe unusual rules governing the vaccine: Medicare won't pay for it, as itdoes flu shots and other vaccines; her doctor doesn't stock it, so she'dneed to pick it up at a pharmacy and bring it back to his office within 30minutes; and her supplemental Medicare Part D prescription drug plandoesn't cover it.As a result, the Columbia resident is just saying no to the shot thatwould cost her $200."I can afford to do it, but I got my back up and I'm not going to," saidson, who regards her refusal as something of a moral issue. "Morepeople should take a stand; $200 is a horrendous amount of money. The drugcompanies are rolling in money and should help pay instead of runningfull-page ads," she said, citing prominent advertisements for the vaccinetaken out by manufacturer Merck earlier this year.Vaccines that are particularly beneficial for older Americans, includingthose for flu and pneumococcal pneumonia, have been fully covered undertraditional Medicare rules. Zostavax is the first vaccine that is -- orisn't -- covered by Medicare Part D drug plans, a byzantine patchwork witha wide variety of rules and reimbursement rates."It's become a free-for-all, " said Schmader, chief of geriatricsat Duke University Medical Center who heads the research committee for theAmerican Geriatrics Society. While most Part D plans cover Zostavax, hesaid, some practices are charging as much as $500 per shot (doctors payabout $150 per dose) in an effort to recoup their overhead. Zostavax,which is a live virus, must be handled carefully and remain frozen untilshortly before it is injected.The result, he said, is that many patients who could benefit from thevaccine and avoid shingles and its severely painful aftermath known aspostherpetic neuralgia -- nerve damage that can persist for months --aren't being immunized. Health officials estimate that 35 million to 40million Americans are candidates for the shot; according to Merck, 1million doses of the vaccine have been sold.Merck spokeswoman Blake said that the company "is workingto address logistical challenges" confronting patients. "Progress is beingmade.""We certainly believe it is priced appropriately and reflects the value ofthis vaccine," she added.Most health plans, Aetna included, require that patients pay doctorsupfront for the full cost of the vaccine and its administration and thenfile for reimbursement."The amount of reimbursement would depend on the plan a person is in,"Aetna spokesman Walt Cherniak said in an e-mail.Some doctors say that while they are enthusiastic about the vaccine, theydon't stock it, fearing they won't be adequately reimbursed. Similarconcerns have affected the availability of Gardasil, another new Merckvaccine aimed at girls and young women that is designed to preventcervical cancer.Washington internist Alice Fuisz said her patients are keen to getZostavax because many have a friend or relative who has endured shingles.She and her partners give such patients a prescription and send themacross the street to a drugstore to pick up the vaccine, which they thenadminister."It's one of the few vaccines we aren't stocking," she said, largelybecause "figuring out the logistics of the payment system soundedoverwhelming." Last year, Fuisz added, her practice bought too much fluvaccine and "lost a lot of money.""We never know what insurance is going to cover," said Joan Irvine,practice administrator for Montgomery Internal Medicine Associates inOlney, which stocks Zostavax. More than 112 patients have been immunizedso far, she said. "The patients end up paying for it, and that's thebiggest problem," she noted, because some who need it can't afford it.Duke's Schmader notes that the uncertainties have created an additionalobstacle for patients: the 30-minute rule.For a 75-year-old with health problems, being told to pick up the vaccineat a pharmacy and bring it back to a doctor's office in half an hour orless may be no easy task."You can see how daunting that might be," he said. ¿Comments:boodmanswashpost.Post a CommentView all comments that have been posted about this article.- - - -1. Cost-benefit analysis of universal varicella vaccination in the U.S.taking into account the closely related herpes-zoster epidemiology.Vaccine. 2005 May 9;23(25):3349-55.Goldman GS.Medical Veritas International (MVI), Pearblossom, CA 93553, USA.pearblossomincaolMany models concur that universal varicella vaccination of children isbeneficial from the perspective of reducing societal costs. Yet, themajority of such cost analyses have been modeled under the assumption thatvaricella vaccination has no adverse effect on the closely relatedherpes-zoster (HZ) epidemiology. Historical models have assumed thatasymptomatic endogenous reactivation is the chief mechanism of boostingthat suppresses the reactivation of HZ and that immunity wanes due to theaging process. Recent studies suggest instead that periodic exogenousexposures to wild-type varicella are the predominant factor influencingthe curve of increasing HZ incidence rate with advancing age amongindividuals <50, after which an age-related decline dominates in theelderly. Based on a realistic age-structured model, we comparedifferences in outcomes of the number of HZ cases and direct medical costsassociated with the population existing in 2000 and as it ages (accordingto the mortality given in the 2000 U.S. census) during the following 50years with and without implementation of universal varicella vaccination.Under universal varicella vaccination, we assume that 15 yearspost-licensure, the boosting mechanism known as asymptomatic endogenousreactivation principally serves to limit HZ incidence to 550 per 100,000person-years in unvaccinated individuals <50 with a previous history ofnatural varicella--since there has been a vaccine-induced decline inexogenous boosting. We estimate universal varicellavaccination has the impact of an additional 14.6 million (42%) HZ casesamong adults aged <50 years during a 50 year time span at a substantialcost burden of 4.1 billion US dollars or 80 million US dollars annuallyutilizing an estimated mean healthcare provider cost of 280 US dollars perHZ case.PMID: 15837242--------------------------------------------------------Sheri Nakken, former R.N., MA, Hahnemannian Homeopath Vaccination Information & Choice Network, Nevada City CA & Wales UKVaccines - http://www.wellwithin1.com/vaccine.htm Email classes startOctober 17 & 18

[Guest guest]

Sheri-

Thank you so much for info. I passed it on to my mom. Hopefully she

will take the time to read it.

Kim

>

>

> An abstract follows the news item.

>

> Vaccination research Goldman concluded:

> " We estimate universal varicella vaccination has the impact of an

> additional 14.6 million (42%) HZ cases among adults aged <50 years

during

> a 50 year time span at a substantial cost burden of 4.1 billion US

dollars

> or 80 million US dollars annually utilizing an estimated mean

healthcare

> provider cost of 280 US dollars per HZ case. " (1)

>

> As with thimerosal, the MMR, and other injectables, the varicella

> vaccination is (from a pharma point of view) remarkably iatrogenic.

>

> Binstock

>

> -

>

> Shingles Vaccine Proves Painful

>

> Patients Confront Stringent Rules, High Prices, Limited Access

>

> By G. Boodman

> Washington Post Staff Writer

> Tuesday, September 25, 2007; HE01

> http://www.washingtonpost.com/wp-

dyn/content/article/2007/09/21/AR2007092101818.html

>

> Clara son is the kind of person public health officials had in

mind

> when they approved the shingles vaccine last year.

>

> At 83, she recently suffered through a painful bout of shingles, a

> reactivation of the dormant virus that causes chickenpox. It was,

she

> recalls, " quite nasty, " an experience she is eager to avoid

repeating.

> With the possibility of a recurrence in mind, her suburban land

> internist urged her to get the shot known as Zostavax, which an

advisory

> committee to the federal Centers for Disease Control and Prevention

has

> recommended for Americans 60 and older.

>

> But son's willingness to be immunized evaporated once she

discovered

> the unusual rules governing the vaccine: Medicare won't pay for it,

as it

> does flu shots and other vaccines; her doctor doesn't stock it, so

she'd

> need to pick it up at a pharmacy and bring it back to his office

within 30

> minutes; and her supplemental Medicare Part D prescription drug plan

> doesn't cover it.

>

> As a result, the Columbia resident is just saying no to the shot

that

> would cost her $200.

>

> " I can afford to do it, but I got my back up and I'm not going to, "

said

> son, who regards her refusal as something of a moral

issue. " More

> people should take a stand; $200 is a horrendous amount of money.

The drug

> companies are rolling in money and should help pay instead of

running

> full-page ads, " she said, citing prominent advertisements for the

vaccine

> taken out by manufacturer Merck earlier this year.

>

> Vaccines that are particularly beneficial for older Americans,

including

> those for flu and pneumococcal pneumonia, have been fully covered

under

> traditional Medicare rules. Zostavax is the first vaccine that is --

or

> isn't -- covered by Medicare Part D drug plans, a byzantine

patchwork with

> a wide variety of rules and reimbursement rates.

>

> " It's become a free-for-all, " said Schmader, chief of

geriatrics

> at Duke University Medical Center who heads the research committee

for the

> American Geriatrics Society. While most Part D plans cover

Zostavax, he

> said, some practices are charging as much as $500 per shot (doctors

pay

> about $150 per dose) in an effort to recoup their overhead.

Zostavax,

> which is a live virus, must be handled carefully and remain frozen

until

> shortly before it is injected.

>

> The result, he said, is that many patients who could benefit from

the

> vaccine and avoid shingles and its severely painful aftermath known

as

> postherpetic neuralgia -- nerve damage that can persist for months -

-

> aren't being immunized. Health officials estimate that 35 million

to 40

> million Americans are candidates for the shot; according to Merck, 1

> million doses of the vaccine have been sold.

>

> Merck spokeswoman Blake said that the company " is

working

> to address logistical challenges " confronting patients. " Progress

is being

> made. "

>

> " We certainly believe it is priced appropriately and reflects the

value of

> this vaccine, " she added.

>

> Most health plans, Aetna included, require that patients pay doctors

> upfront for the full cost of the vaccine and its administration and

then

> file for reimbursement.

>

> " The amount of reimbursement would depend on the plan a person is

in, "

> Aetna spokesman Walt Cherniak said in an e-mail.

>

> Some doctors say that while they are enthusiastic about the

vaccine, they

> don't stock it, fearing they won't be adequately reimbursed. Similar

> concerns have affected the availability of Gardasil, another new

Merck

> vaccine aimed at girls and young women that is designed to prevent

> cervical cancer.

>

> Washington internist Alice Fuisz said her patients are keen to get

> Zostavax because many have a friend or relative who has endured

shingles.

> She and her partners give such patients a prescription and send them

> across the street to a drugstore to pick up the vaccine, which they

then

> administer.

>

> " It's one of the few vaccines we aren't stocking, " she said, largely

> because " figuring out the logistics of the payment system sounded

> overwhelming. " Last year, Fuisz added, her practice bought too much

flu

> vaccine and " lost a lot of money. "

>

> " We never know what insurance is going to cover, " said Joan Irvine,

> practice administrator for Montgomery Internal Medicine Associates

in

> Olney, which stocks Zostavax. More than 112 patients have been

immunized

> so far, she said. " The patients end up paying for it, and that's the

> biggest problem, " she noted, because some who need it can't afford

it.

>

> Duke's Schmader notes that the uncertainties have created an

additional

> obstacle for patients: the 30-minute rule.

>

> For a 75-year-old with health problems, being told to pick up the

vaccine

> at a pharmacy and bring it back to a doctor's office in half an

hour or

> less may be no easy task.

>

> " You can see how daunting that might be, " he said. ¿

>

> Comments:boodmans@...

>

> Post a Comment

>

> View all comments that have been posted about this article.

>

> - - - -

>

> 1. Cost-benefit analysis of universal varicella vaccination in the

U.S.

> taking into account the closely related herpes-zoster epidemiology.

>

> Vaccine. 2005 May 9;23(25):3349-55.

>

> Goldman GS.

> Medical Veritas International (MVI), Pearblossom, CA 93553, USA.

> pearblossominc@...

>

> Many models concur that universal varicella vaccination of children

is

> beneficial from the perspective of reducing societal costs. Yet, the

> majority of such cost analyses have been modeled under the

assumption that

> varicella vaccination has no adverse effect on the closely related

> herpes-zoster (HZ) epidemiology. Historical models have assumed that

> asymptomatic endogenous reactivation is the chief mechanism of

boosting

> that suppresses the reactivation of HZ and that immunity wanes due

to the

> aging process. Recent studies suggest instead that periodic

exogenous

> exposures to wild-type varicella are the predominant factor

influencing

> the curve of increasing HZ incidence rate with advancing age among

> individuals <50, after which an age-related decline dominates in the

> elderly. Based on a realistic age-structured model, we compare

> differences in outcomes of the number of HZ cases and direct

medical costs

> associated with the population existing in 2000 and as it ages

(according

> to the mortality given in the 2000 U.S. census) during the

following 50

> years with and without implementation of universal varicella

vaccination.

> Under universal varicella vaccination, we assume that 15 years

> post-licensure, the boosting mechanism known as asymptomatic

endogenous

> reactivation principally serves to limit HZ incidence to 550 per

100,000

> person-years in unvaccinated individuals <50 with a previous

history of

> natural varicella--since there has been a vaccine-induced decline in

> exogenous boosting. We estimate universal varicella

> vaccination has the impact of an additional 14.6 million (42%) HZ

cases

> among adults aged <50 years during a 50 year time span at a

substantial

> cost burden of 4.1 billion US dollars or 80 million US dollars

annually

> utilizing an estimated mean healthcare provider cost of 280 US

dollars per

> HZ case.

> PMID: 15837242

>

[Guest guest]

An abstract follows the news item.

Vaccination research Goldman concluded:

" We estimate universal varicella vaccination has the impact of an

additional 14.6 million (42%) HZ cases among adults aged <50 years during

a 50 year time span at a substantial cost burden of 4.1 billion US dollars

or 80 million US dollars annually utilizing an estimated mean healthcare

provider cost of 280 US dollars per HZ case. " (1)

As with thimerosal, the MMR, and other injectables, the varicella

vaccination is (from a pharma point of view) remarkably iatrogenic.

Binstock

-

Shingles Vaccine Proves Painful

Patients Confront Stringent Rules, High Prices, Limited Access

By G. Boodman

Washington Post Staff Writer

Tuesday, September 25, 2007; HE01

http://www.washingtonpost.com/wp-dyn/content/article/2007/09/21/AR2007092101818.\

html

Clara son is the kind of person public health officials had in mind

when they approved the shingles vaccine last year.

At 83, she recently suffered through a painful bout of shingles, a

reactivation of the dormant virus that causes chickenpox. It was, she

recalls, " quite nasty, " an experience she is eager to avoid repeating.

With the possibility of a recurrence in mind, her suburban land

internist urged her to get the shot known as Zostavax, which an advisory

committee to the federal Centers for Disease Control and Prevention has

recommended for Americans 60 and older.

But son's willingness to be immunized evaporated once she discovered

the unusual rules governing the vaccine: Medicare won't pay for it, as it

does flu shots and other vaccines; her doctor doesn't stock it, so she'd

need to pick it up at a pharmacy and bring it back to his office within 30

minutes; and her supplemental Medicare Part D prescription drug plan

doesn't cover it.

As a result, the Columbia resident is just saying no to the shot that

would cost her $200.

" I can afford to do it, but I got my back up and I'm not going to, " said

son, who regards her refusal as something of a moral issue. " More

people should take a stand; $200 is a horrendous amount of money. The drug

companies are rolling in money and should help pay instead of running

full-page ads, " she said, citing prominent advertisements for the vaccine

taken out by manufacturer Merck earlier this year.

Vaccines that are particularly beneficial for older Americans, including

those for flu and pneumococcal pneumonia, have been fully covered under

traditional Medicare rules. Zostavax is the first vaccine that is -- or

isn't -- covered by Medicare Part D drug plans, a byzantine patchwork with

a wide variety of rules and reimbursement rates.

" It's become a free-for-all, " said Schmader, chief of geriatrics

at Duke University Medical Center who heads the research committee for the

American Geriatrics Society. While most Part D plans cover Zostavax, he

said, some practices are charging as much as $500 per shot (doctors pay

about $150 per dose) in an effort to recoup their overhead. Zostavax,

which is a live virus, must be handled carefully and remain frozen until

shortly before it is injected.

The result, he said, is that many patients who could benefit from the

vaccine and avoid shingles and its severely painful aftermath known as

postherpetic neuralgia -- nerve damage that can persist for months --

aren't being immunized. Health officials estimate that 35 million to 40

million Americans are candidates for the shot; according to Merck, 1

million doses of the vaccine have been sold.

Merck spokeswoman Blake said that the company " is working

to address logistical challenges " confronting patients. " Progress is being

made. "

" We certainly believe it is priced appropriately and reflects the value of

this vaccine, " she added.

Most health plans, Aetna included, require that patients pay doctors

upfront for the full cost of the vaccine and its administration and then

file for reimbursement.

" The amount of reimbursement would depend on the plan a person is in, "

Aetna spokesman Walt Cherniak said in an e-mail.

Some doctors say that while they are enthusiastic about the vaccine, they

don't stock it, fearing they won't be adequately reimbursed. Similar

concerns have affected the availability of Gardasil, another new Merck

vaccine aimed at girls and young women that is designed to prevent

cervical cancer.

Washington internist Alice Fuisz said her patients are keen to get

Zostavax because many have a friend or relative who has endured shingles.

She and her partners give such patients a prescription and send them

across the street to a drugstore to pick up the vaccine, which they then

administer.

" It's one of the few vaccines we aren't stocking, " she said, largely

because " figuring out the logistics of the payment system sounded

overwhelming. " Last year, Fuisz added, her practice bought too much flu

vaccine and " lost a lot of money. "

" We never know what insurance is going to cover, " said Joan Irvine,

practice administrator for Montgomery Internal Medicine Associates in

Olney, which stocks Zostavax. More than 112 patients have been immunized

so far, she said. " The patients end up paying for it, and that's the

biggest problem, " she noted, because some who need it can't afford it.

Duke's Schmader notes that the uncertainties have created an additional

obstacle for patients: the 30-minute rule.

For a 75-year-old with health problems, being told to pick up the vaccine

at a pharmacy and bring it back to a doctor's office in half an hour or

less may be no easy task.

" You can see how daunting that might be, " he said. ¿

Comments:boodmans@....

Post a Comment

View all comments that have been posted about this article.

- - - -

1. Cost-benefit analysis of universal varicella vaccination in the U.S.

taking into account the closely related herpes-zoster epidemiology.

Vaccine. 2005 May 9;23(25):3349-55.

Goldman GS.

Medical Veritas International (MVI), Pearblossom, CA 93553, USA.

pearblossominc@...

Many models concur that universal varicella vaccination of children is

beneficial from the perspective of reducing societal costs. Yet, the

majority of such cost analyses have been modeled under the assumption that

varicella vaccination has no adverse effect on the closely related

herpes-zoster (HZ) epidemiology. Historical models have assumed that

asymptomatic endogenous reactivation is the chief mechanism of boosting

that suppresses the reactivation of HZ and that immunity wanes due to the

aging process. Recent studies suggest instead that periodic exogenous

exposures to wild-type varicella are the predominant factor influencing

the curve of increasing HZ incidence rate with advancing age among

individuals <50, after which an age-related decline dominates in the

elderly. Based on a realistic age-structured model, we compare

differences in outcomes of the number of HZ cases and direct medical costs

associated with the population existing in 2000 and as it ages (according

to the mortality given in the 2000 U.S. census) during the following 50

years with and without implementation of universal varicella vaccination.

Under universal varicella vaccination, we assume that 15 years

post-licensure, the boosting mechanism known as asymptomatic endogenous

reactivation principally serves to limit HZ incidence to 550 per 100,000

person-years in unvaccinated individuals <50 with a previous history of

natural varicella--since there has been a vaccine-induced decline in

exogenous boosting. We estimate universal varicella

vaccination has the impact of an additional 14.6 million (42%) HZ cases

among adults aged <50 years during a 50 year time span at a substantial

cost burden of 4.1 billion US dollars or 80 million US dollars annually

utilizing an estimated mean healthcare provider cost of 280 US dollars per

HZ case.

PMID: 15837242