A tip for Australians with Chronic Lymphocytic Leukemia trying to access pneumococcal vaccination through the National Immunisation Program

[CLLerinOz]

What a morning I've had to get my third pneumococcal vaccine. I'll share the details here as the solution I found could help others with CLL in Australia who are having difficulty accessing these vaccines through the National Immunisation Program (NIP).

In Australia, since 1 July 2020, it's standard for those over 70 to be given only one pneumococcal vaccination (Prevnar 13 - PCV13) for free as a part of the National Immunisation Program. (Prevnar 20 is not yet included in Australia's National Immunisation Program.)

However, patients with CLL are advised to receive Prevnar 13 followed 2-12 months later by Pneumovax 23 - 23PPV - as soon as possible after they are diagnosed and then to receive an additional Pneumovax 23 vaccine a minimum of five years after their previous Pneumovax dose. Even if they are under 70 years of age, a CLL patient will be funded to receive those three vaccinations free of charge under the National Immunisation Program.

However, the problem comes when, as I did today, the patient tries to get those vaccines. In my case, it was my third vaccine. I had my Prevnar 13 and Pneumovax 23 in 2017. Back in 2017, I had to self-fund the vaccines as they weren't available for free through the NIP to anyone under 70. That's since changed and those with CLL are able to access them through the NIP as described above.

There are variations on the reasons you might be given to refuse access to the vaccines now through the NIP:

"It's not possible, we only give it to people over 70". WRONG for CLL

"It's not possible. You've completed your vaccination for pneumococcal because you've had Prevnar 13 and Pneumovax 23". WRONG for CLL

"It's possible but you'll have to pay for the vaccine." WRONG for CLL

When I couldn't get anywhere with my assurances that I was eligible for a free, third pneumococcal vaccine on the basis of having CLL, the nurse at my GP practice said she'd enter my details into the Pneumovax calculator (whatever that is) and it would definitively assess my eligibility.

The result came back saying I was eligible to have a second Pneumovax 23 dose in addition to my previous Prevnar 13 + Pneumovax 23 but that I would have to self-fund it - ie it wouldn't be funded through the NIP.

When the nurse showed me the printout, I saw that she'd entered my condition as "immunosuppressive therapy - where sufficient vaccine response is required".

I explained that I was eligible based on my condition regardless of any therapy and asked her to try again to see if she could enter my condition rather than my treatment.

This time she selected 'haematological malignancies' from the drop-down box and, et voila, it showed I am eligible for a three-course vaccination (Prevnar 13 + after 2 -12 months Pneumovax 23 + after a minimum of 5 years another Pneumovax 23) and that it would all be funded under the National Immunisation Program at no cost to the patient.

Eureka! Given the consultation started with me refusing to pay for a vaccine at the pharmacy that I'm entitled to get free through the NIP and then being told by the GP practice nurse that I could only be vaccinated against Pneumococcal if I were over 70, it ended up being a good outcome in the end.

I've attached printouts of the calculator's result sheets with my personal details blanked out - one to show what it looked like when I was finally approved and another in a reply to show what it looked like when earlier I was told incorrectly that I could get the additional Pneumovax 23 but would have to self-fund the vaccine.

Feel free to take a copy of the images to your health practice when you're requesting pneumococcal vaccination. If your practice staff use the Pneumovax calculator (or perhaps it's called a Pneumococcal calculator), ensure they enter 'haematological malignancy' as your condition. It might save you the hour I lost trying to get approval, along with some $$.

You'll find more about vaccinations for CLL patients in our pinned post which I'll update with a link to this information.

healthunlocked.com/cllsuppo...

Here's a link to Australia's updated National Immunisation Schedule:

health.gov.au/sites/default...

Good luck!

CLLerinOz

[CLLerinOz Administrator Volunteer]

Here's what the report looked like when I was rejected by the calculator. The image attached to the post shows what the report looked like when I was accepted.

Vaccination report from 'pneumovax calculator' - ineligible for funding report