I just checked to see if the Iowa Board of Pharmacy rules had changed about the recommendation that a physician and patient shared decision-making discussion should help clarify whether and why a prescription would be necessary to enable a patient over the age of 60 years to get the Respiratory Syncytial Virus (RSV) vaccine.
I found out that nothing has changed the position of the Iowa Board of Pharmacy on this issue, despite the CDC published list which now includes the RSV vaccine (which seemed to be the main issue against allowing pharmacists to administer the vaccine independently). I finally found the CDC Adult Immunization Schedule by Age web page. The section shows a table of vaccines recommendations broken down by age. Below the table is a list of the CDC recommended vaccines. Under the RSV category there is a Special Situation section with guidance for those over the age of 60 regarding those most likely to benefit from the RSV vaccine:
- “Age 60 years or older: Based on shared clinical decision-making, 1 dose RSV vaccine (Arexvy® or Abrysvo™). Persons most likely to benefit from vaccination are those considered to be at increased risk for severe RSV disease.** For additional information on shared clinical decision-making for RSV in older adults, see www.cdc.gov/vaccines/vpd/rsv/downloads/provider-job-aid-for-older-adults-508.pdf.
For further guidance, see www.cdc.gov/mmwr/volumes/72/wr/mm7229a4.htm
**Note: Adults age 60 years or older who are at increased risk for severe RSV disease include those with chronic medical conditions such as lung diseases (e.g., chronic obstructive pulmonary disease, asthma), cardiovascular diseases (e.g., congestive heart failure, coronary artery disease), neurologic or neuromuscular conditions, kidney disorders, liver disorders, hematologic disorders, diabetes mellitus, and moderate or severe immune compromise (either attributable to a medical condition or receipt of immunosuppressive medications or treatment); those who are considered to be frail; those of advanced age; those who reside in nursing homes or other long-term care facilities; and those with other underlying medical conditions or factors that a health care provider determines might increase the risk of severe respiratory disease.”
While the rationale for the recommendation is clear, it’s interesting that Iowa is one of only 4 states in which pharmacists cannot administer the RSV vaccine independently (meaning a physician prescription is necessary). The RSV vaccine is in the CDC published vaccination schedule, which looks like it would satisfy the Iowa Code Section 155A.46 according to the Iowa Board of Pharmacy.
I still wonder whether it’s the shared decision-making discussion or the Iowa Code that’s the main reason a physician prescription is necessary to get the RSV vaccine.
It isn’t that I want the RSV vaccine. In fact, based on what I’ve read on the CDC Immunization Schedule, I don’t think I need it because I’m pretty healthy for a geezer. I just don’t understand why only 4 states require a physician prescription. Does that mean the pharmacists in the rest of the country are confident they can have a shared decision-making discussion with patients about the indication for the RSV vaccine?
Go Retire Psychiatrist 