PCV 20 Guidelines ? Get 20 if you already had 13 and 23 - or not ?

[janvog]

One pharmacist in Florida refused to give PCV 20 "because guidelines say that if you had other previous pneumo vaccinations you do not need PCV 20 !" I got PCV 13 in 2015 and PCV 23 in 2005. My understanding of the literature is that PCV20 is now "updated" and everybody should get it who may get it on medical and age eligibility. My Primary and my CLL Specialist both agreed that I should get PCV 20 now . What is your view ?

[caven]

Get the PCV 20 vaccine pronto.

Whenever you have your primary care doctor, your CLL specialist and logic telling you that there's a benefit to getting an 'update' to a medicine ... then take that advice!

Caven

[janvog in reply to caven]

Thank you! I just called United Insurance and was assured that they would pay for the PCV 20 vaccination.

[lankisterguy Volunteer]

Have one of the doctors write a prescription for the PCV20 and issue it on paper or electronically - whichever is easier for you, to whatever pharmacy is convenient, then the pharmacist is not responsible and does not have discretion.

[janvog in reply to lankisterguy]

I now read the CDC Guidelines. It simply states for 65+ who have already received both PPSV23 and PCV 13: "The incremental public health benefit has not been evaluated. " I am 88, both my primary and oncologist approved it. (It has updated elements and therefore I will get PCV 20. )

[SofiaDeo]

My view is that this pharmacist is probably in a retail setting, not a hospital let alone one that does specialized oncology work. The latter 2 might possibly do it.

Pharmacist vaccination prescribing authorizations in the US allow pharmacists to give vaccines *without a prescription* as outlined in specific state guidelines. So they generally won't be willing to just step outside these; in fact, the scope of their vaccination authority probably says they can't. It does not authorize them to deny any Rx from a doctor that differs from the guidelines, however. So IMO your doc will need to call in an RX, or write one out for you to present, if you want to get it at a local retail place. A statement like "my cancer (I assume they know you have CLL) has different vaccination guidelines than people who don't have this cancer" will probably be helpful when you give them the prescription. And if either your GP or your hem-onc *prescribe* it, they do not have the authority to contradict. Question it to verify, yes, but they really can't refuse if you have a prescription. FWIW, although the package insert doesn't address our situation of repeat vaccines, the American Society of Hematology has an opinion on our vaccination requirements, which is likely where your hem-onc if not your GP are citing as the reason for us to get extra compared to the general population.

Things like this is one reason why I get all the vaccines I can, at a physicians office. My GP took my word for it when I said "my CLL doc says I need the high dose flu vaccine". I wasn't going to argue with some pharmacist about it, or try to present a prescription. I got my Prevnar-20 at my CLL specialists, even though I have had previous pneumonia vaccines, in my chart. The staff at a doc's office won't have a problem giving vaccinations as ordered.

The place I get my Covid vaccines, has my immune compromised disease noted in their system, and the state I get these in had already authorized everyone to do the exceptions, so I didn't have a problem getting the "more frequent" Covid boosters. Some places may not have done this, so those people will need an Rx for a booster sooner than the "general public" guidelines.

[janvog]

The new, young supermarket pharmacist simply found a convenient vague statement on an info sheet which allowed her to discourage me. But I now read the entire CDC guidance: It seems the manufacturer simply did not investigate whether a PCV 20 would provide "incremental public health benefits" for 65+ who had already the other two pneumo vaccinations in the past. Of course I will get the PCV 20 !

[SofiaDeo in reply to janvog]

Ahh, a young one to boot. Early into a career, one is not as confident in our knowledge base, and doesn't have the experience to know when things are "guidelines" versus "hard requirements". And unfortunately most of the retail software systems, do not allow one to chart exceptions, like a health care setting can. So it's CYA all the way, better to be safe than sorry. Patients *do* threaten to, and actually try to, sue as well as make complaints against our license.

[janvog in reply to SofiaDeo]

Yes, I always go max and will get it ! ( I got unique videos for you: TAHITI UKULELE RECORD )

[bkoffman CLL CURE Hero]

I got mine months ago, before Medicare paid for it. OUCH! Glad I did.

[janvog]

As a lay person I read the CDC Guideline on PCV20 and I did not notice a reason why a the PCV20 should not be given to those over 65 who had (as I had) already PPV23 and PCV13 in prior years. Instead there is the statement after the +65 paragraph: "The incrimental public health benefit of providing PVC20 to adults (now I am not sure if it meant 65+) who have received both PCV13 and PPSV23 has not been evaluated". (!) Thus, it is not known because it was not investigated. But it is considered to be effective for those under 65 with or without prior 12 and 23 ? My understanding from news items is that PVC20 is "updated" to defend against additional and new problems. It would be interesting to read the interpretation of CDC PCV20 Guideline as written by a professional .

[Teddo]

There clearly is not full agreement among practitioners. Prior to reading this post I saw my local hem/onc today and asked whether I need the PVC20 b/c I had the earlier two 6 and 7 years ago. He said no as did my primary doc when I asked him previously.

[janvog in reply to Teddo]

I just looked at Tahiti TV. They too are vaccinating for influenza and Covid today. As an "Oversea Province" of France they have world class medical care. One thing they also got: Relaxation as societal norm. Videos: Tahiti Ukulele Record