RSV vaccination

[TeamDirtyBoots]

I'm having trouble getting the new RSV vaccination that my hematologist recommended (in addition to my annual flu shot and the latest Covid booster). Wondering if anyone has any suggestions.

Fyi, I live in California, USA and have private Blue Shield insurance, which is usually pretty good. They say its covered, but only if given in a doctor's office. Problem is doctors offices don't stock this new vaccine. In addition to my hematologist (at UCSF) I've asked my PCP and my oncologist. All say get it at a pharmacy.

I've already talked with one of the Information Specialists at LLS, who didn't have any other ideas.

If I was 65 and on medicare it'd be covered, but I'm only 60. 🙂 I've read a lot of people are having similar problems obtaining this new RSV vaccine. That insurance companies are dragging their feet approving it at pharmacies. It cost $300 out of pocket, so I'd rather not just pay for it.

Any ideas? Thanks!

[Hilomom]

We live in Hawaii and got our RSV at tge Target pharmacy, which is operated by CVS. There was no charge. We are also covered under a BCBS plan.

[lankisterguy Volunteer]

Hi TeamDirtyBoots,

-

If you get your PCP or oncologist doctor to write a prescription for the RSV shot and had that script transmitted to a major pharmacy like CVS, would your insurance cover it?

-

Len

[Dinasantos]

Go to a walk in clinic.

[bachplayer13]

im in texas. also bcbs. at cvs there was no charge. my info was the same from bcbs must be given at a docs office and i found my docs didn't have it in stock. decided to get the shot anyway and pleasantly suprised it seems to be covered. its been several weeks and no bills have shone up but who's to say they won't eventually. bcbs also said it would be covered if the pharm i wehnt to had a 'mini clinic ie a room they take you in to admin the shot. i did not make an appt at a legit mini clinic at one of the pharms as none of them had it in stock and they charge extra to admin a shot and see you in the mini clinic as if you are sick.

the cvs i went to which was not listed as one of the mini clinic does take you into a lttle cubicle to admin the shot so maybe that's why it was covered? good luck. that being said i felt pretty punk after the shot for at least 5 days. no fever but very strange head floating above the clouds sensation, weak nauseous, not myself. after aboutg a week i was back to normal. i've not heard anyone else describe their reaction that way. usually just a sore arm and headache. but mine was a real out of body experience one i've never had before to any other vaccine

[beanlake14]

I am in MO, and discovered that I need a prescription for it. I called my oncologist who called it in to Walgreens because they had it. If I were you, I would search, Walgreens, CVS, even HyVee if you have that store there.

[SofiaDeo]

My specialist says our area isn't getting it until November & I will get it at his office then, perhaps it's just not shipped to your area yet. I know my GP got regular flu vaccine but the high dose isn't in yet. Flu shots have shipped later than usual in my region.

[TeamDirtyBoots]

Hi All,

Thank you all for your replies and ideas. I've already tried or thought of most of them.

At this point, I will have my doctor send a prescription for the vaccine. I finally got BSBC to send me an email stating that it *should* then be covered at the pharmacy because the doctor's office doesn't have it in stock. Pharmacist said she could tell it would still be declined at the pharmacy, but at least I'll have something to argue with after I submit the claim myself and if/when I have to appeal.

Fyi, regarding other thoughts/suggestions:

- only a few pharmacies here have the wellness clinics as bachplayer13 suggested. Good idea. I'll try one of those first.

- I've tried a shot clinic. They're all giving only flu, Covid boosters (and Monkey Pox) vaccines.

- I've tried getting at both a Walgreens and a CVS in a Target store. They have it in stock, just the darn bsbc computer says not covered unless given at doctor's office.

- two of my doctors are at a major medical center (UCSF), none have any indication that they'll have it anytime soon.

Thanks!

[TeamDirtyBoots]

Hi All,

Just wanted to let you know I was finally able to get the RSV vaccination.

I think this experience was a reminder of how we all need to be a strong advocate to get the health care we need. In this case, it took me three pharmacy appointments, 5 long calls with my insurer (BCBS) and multiple messages with my doctor's office to get them to send a prescription to the pharmacy so BSBC would pay for the vaccine. And this was just for a vaccination.

It would have easier for me to just pay the $295 out of pocket. I also posted about this on the Leukemia & lymphoma Society (LLS) CLL blog and after someone else responded that they've had the same problem the moderator wrote they forwarded the info to the LLS Office of Public Policy.

Hopefully, it will get easier to get the RSV vaccine when its not so new.