Herpes Zoster Vaccine: What Is Interfering with Uptake?

Background:
The zoster vaccine, licensed in 5/2006, is the first vaccine to be reimbursed through Medicare Part D. Uptake in the first year was low at 2% nationally.

Objectives:
To assess among general internists (GIM) and family (FM) physicians 1) current vaccination practices, 2) barriers to vaccination, and 3) knowledge and practice regarding reimbursement for zoster vaccine.

Methods:
A mail and internet-based national survey of a representative network of GIM and FM physicians was conducted between July-September 2008.

Results:
Response rates were 72% in both specialties (301 GIM, 297 FM respondents). Both specialties reported similar methods for delivering vaccine including stocking and administering in their office (51%); referring patients to a pharmacy to purchase vaccine and bring it back to the office for administration (39%); referring to a pharmacy for administration there (33%); and referring to a Public Health Department (23%). Forty-five percent of GIM and 38% of FM reported strongly recommending zoster compared to > 90% strongly recommending influenza and pneumococcal vaccinations. For both specialties, the most frequently reported barriers to vaccination were financial, including reimbursement problems for their practice, physician concerns about costs for patients, and “up-front” costs for their practice of purchasing the vaccine. Only 45% of respondents knew the vaccine is reimbursed through Medicare Part D. Among both specialties, asking the patient to call his/her Medicare Part D or private insurance plan was the most common strategy to identify coverage. Among providers who reported not stocking or administering, 46% reported they would be much more likely to provide vaccine in their office if it were covered by Medicare Part B.

Conclusions:
Barriers to optimal adoption of the zoster vaccine may include lack of uniform support from physicians, lack of knowledge regarding reimbursement, reliance on patients to determine coverage and physicians' concerns regarding upfront costs and reimbursement.