COVID-19 vaccines will move onto the National Immunisation Program later this week. Who is now eligible for a funded vaccine and what should pharmacists tell patients who aren’t?
COVID-19 vaccination enters a new phase from 1 October, with vaccines moving from the standalone COVID-19 vaccination program into the National Immunisation Program (NIP).
AP spoke with Julianna Neill MPS, PSA Vaccination Ambassador, community pharmacist and owner of Pharmacy for Life, to explore the new eligibility criteria, who would still benefit from a COVID-19 vaccine and the operational changes required before the move takes effect.
Who is still eligible to get a funded COVID-19 vaccine?
From 1 October, funded COVID-19 vaccination will only be available to Medicare-eligible people in the following groups:
- adults aged 75 years and over – two doses per year, approximately 6 months apart
- adults aged 65–74 years – one dose per year
- Aboriginal and Torres Strait Islander people aged 50–74 years – one dose per year
- adults aged 18–64 years with severe immunocompromise – one dose per year.
People outside these groups will not be eligible for a funded COVID-19 vaccine through the NIP, although they may be able to access vaccination privately still access vaccination privately following an individual benefit–risk discussion with a healthcare professional.
What’s classified as ‘severe immunocompromise’?
One area which still causes confusion is the cohort who meets the definition of ‘severe immunocompromise’ – but it’s a smaller cohort than most people think.
Ms Neill reminded pharmacists that it does not include the majority of people with chronic conditions that place them at increased risk of severe COVID-19 such as diabetes, heart disease or chronic obstructive pulmonary disease.
‘Severely immunocompromised patients are [typically] people with organ transplants, stem cell recipients, people with blood cancers, or people who are suppressed by autoimmune therapies or cancer therapies,’ she said.
Does ‘consider’ mean the vaccine is no longer recommended for this cohort?
No. The guidance from ATAGI and the Australian Immunisation Handbook has not changed. What has changed is that only ‘recommend’ and not ‘consider’ cohorts will be NIP-funded for COVID-19 vaccine.
For patients outside the NIP-eligible groups, pharmacists will need to discuss the individual’s circumstance and if appropriate, the costs of private vaccination.
What are the out-of-pocket costs?
Patients who are no longer eligible for a funded COVID-19 vaccine will need to pay privately, with the vaccine itself expected to cost around $130–$150, Ms Neill said.
Pharmacies should consider contacting patients with bookings after 1 October who may no longer be eligible, so they are not surprised by an out-of-pocket cost when they arrive.
‘A lot of pharmacy groups are also sending SMS [notifications] to certain groups of patients to let them know this change is coming on 1 October, and if you are wanting a vaccine, get your bookings in now,’ Ms Neill said.
‘We’re using social media platforms to get that message out because there will be some people in that younger age group [who need to be aware].’
Communication regarding COVID-19 vaccines on social media must comply with advertising restrictions for regulated health services and therapeutic goods.
How can pharmacists explain the changes to patients?
It’s important to explain that COVID-19 has transitioned from a pandemic into an endemic phase.
The PSA’s inaugural Vaccination Ambassador Anna Theophilos MPS explained how:
‘COVID is very different to where it was a few years ago, but it hasn’t disappeared.
We’re seeing far fewer deaths than during the pandemic, but the risk of becoming seriously unwell is still greater for people who are older or have certain medical conditions.
That’s why we’re now focusing more closely on protecting the people at greatest risk.’
To answer those wondering why the vaccine is no longer funded for them, Ms Theophilos recommends saying:
‘During the pandemic, COVID vaccination was funded through a universal program so everyone could access vaccination.
‘From 1 October, COVID vaccination is moving into the National Immunisation Program, bringing it more in line with the way we fund other vaccines.
‘Government funding will now be more targeted towards people at greatest risk of becoming seriously unwell.
‘But whether a vaccine is funded and whether it may be appropriate for you are two different questions. We can look at your individual risk and the current recommendations together.’
What do pharmacies need to do before 1 October?
Pharmacists should consider the operational impact of the changes, particularly during the transition between the two programs.
Vaccinations given before 1 October will continue to be claimed under the existing COVID-19 vaccination program, with claims for those vaccinations due by 31 October.
COVID-19 vaccination from 1 October onwards will need to be claimed under the NIPVIP Program, if the patient meets the eligibility criteria. Pharmacies will need to update their ordering and claiming systems to reflect these new arrangements.
Staff training about the changes will also be important, Ms Neill said.
‘It’s all very well pharmacists knowing, but it’s usually the staff who are the first ones that take that phone call or have that conversation when someone comes in,’ she said.
‘We know that pharmacy is one of the most accessible places to get vaccines, so make sure that you and your staff are knowledgeable.’
Explore practical strategies for supporting vaccination with this CPD on increasing vaccination rates in adolescents.
