How pharmacists can overcome NIPVIP confusion

Industry
By
Chloe Hava
-
NIPVIP

While the National Immunisation Program Vaccinations in Pharmacy (NIPVIP) Program has been underway for almost a month, eligibility is still a murky area for many patients and pharmacists alike.

Along with eligibility complexities, regulations are tricky and highly variable across jurisdictions. 

So which patients would benefit from NIPVIP vaccines, and how do you find them?

Australian Pharmacist explores a few case studies that may throw you for a loop, as well as a handy set of essential resources, including an upcoming webinar hosted by PSA.

Shingles vaccine in New South Wales

A 55-year-old male patient with type 2 diabetes presents at a rural New South Wales pharmacy for a COVID-19 booster dose to protect him from the new Omicron sub-variant.

During the consultation, he also mentions that he would like to receive a Shingrix vaccine. 

The patient is worried that having diabetes puts him at a greater risk of contracting shingles. He is also concerned about developing post-herpetic neuralgia, common in patients with type 2 diabetes due to reduced immunity.

The patient heard the news last year that Shingrix replaced Zostavax on the NIP. Having heard about the vaccine’s efficacy through family and friends, and that patients who are immunocompromised are eligible to receive it, he asks if the vaccine can be co-administered with the COVID-19 booster.

The pharmacist informs the patient he will have to pay the out-of-pocket costs to receive the Shingrix vaccine. With a two-dose schedule, this would be hundreds of dollars.

Why?

Within the NSW Pharmacist Vaccination Standard, pharmacists in NSW are legally able to authorise and administer a Shingrix vaccine to any patient 18 years of age and over. However, pharmacists immunisers must adhere to the recommendations of the Australian Immunisation Handbook. In the case of Shingrix, the Handbook recommends vaccination for all immunocompetent people aged ≥50 years.

The only people under the age of 65 eligible for an NIP-funded Shingrix vaccine are Aboriginal and Torres Strait Islander adults aged ≥50, and immunocompromised adults aged ≥18 years with selected severe immunocompromising conditions putting them at the highest risk of herpes zoster, specifically:

  • haemopoietic stem cell transplant
  • solid organ transplant
  • haematological malignancy
  • advanced or untreated HIV.

As this patient is not eligible for an NIP-funded vaccine, a NIPVIP payment for administration is not possible.

Flu shots in Queensland

A mother and a 4-year-old boy walk into a busy South Brisbane pharmacy in March, seeking a flu vaccine ahead of a planned overseas trip to Argentina the following month.

While the boy has had regular flu vaccinations since 6 months of age, the mother hasn’t had one in a few years, and was excited to hear that she can now receive a free vaccination following the 1 January vaccination program commencement.

After screening the patients and checking the Australian Immunisation Register (AIR) to ensure both have not received the influenza vaccine this season, the pharmacist prepares to administer and claim for both vaccines. However, neither patient is eligible for a NIPVIP payment. But they can both still receive the vaccine with no out-of-pocket costs.

Why?

Queensland is the only Australian jurisdiction where pharmacists are authorised to administer influenza vaccines to patients under 5 years of age, with the Extended Practice Authority allowing vaccination by pharmacists from 6 months of age. However, while the vaccine is funded by the NIP for children 6 months to <5 years and Aboriginal and Torres Strait Islander people aged ≥6 months, NIPVIP does not cover vaccination events for children under 5 years of age. In good news, the boy’s administration fee will be fully funded through the state government free flu vaccine program.

Meanwhile, while influenza vaccination is recommended for all people over 6 months, only adults >65 years of age, Aboriginal and Torres Strait Islander people aged ≥5 years of age, pregnant women and people with specific health conditions are able to access NIP vaccines and NIPVIP vaccine administration fees. In this case, the mother doesn’t have any of those conditions, so is ineligible for NIP vaccines and NIPVIP. 

However, the Queensland Government will pay for the cost of the vaccine and the administration fee as part of the state’s free flu vaccine program – announcing in November 2023 that it would cover the full cost of the vaccine and administration fees for any person not covered by the NIP and NIPVIP for the program duration (yet to be confirmed) in 2024.

HPV vaccine in Tasmania

A 17-year old Hobart-based teenager visits her local pharmacy for a flu shot post-Easter. After checking AIR, the pharmacist can see that the patient was vaccinated against influenza last year, received COVID-19 vaccines in 2021 and received one dose of the HPV vaccine in 2020. 

The pharmacist discusses the importance of the full-course HPV vaccination to help protect patients against cervical cancer, pointing out that this ideally takes place around 12–13 years of age, before becoming sexually active and exposure to HPV, but can be administered up to the age of 25.

The patient missed the second dose of her HPV vaccine through Tasmania’s school-based immunisation program for year 7 students due to COVID-19 restrictions.

After checking the Australian Immunisation Handbook, the pharmacist realises he can’t administer a catch-up HPV vaccine to the patient.

Why?

Pharmacists in Tasmania can administer the HPV vaccine to patients 10 years and older through the NIP. However, catch-up vaccination is not required for this patient, as the HPV vaccine schedule is now a single dose for patients 9–25 years of age (except when immunocompromised). Therefore, this patient is considered fully vaccinated against HPV. This change occurred in February 2023.

Helpful resources

Still have questions about jurisdictional regulations and patient eligibility?

Key resources to help you navigate the complexities of the NIPVIP program include:

By attending PSA’s NIP webinar this Wednesday (31 January), you’ll hear further real-life case studies and learn more about:

  • regulation variations across jurisdictions
  • assessing patient eligibility per jurisdiction
  • advice around promoting multiple vaccinations to ensure optimum patient coverage
  • logistical arrangements for storage and record keeping of vaccines 
  • processes for remuneration for administering vaccines.

Become a vaccine provider of choice by learning how to apply the NIPVIP rules yourself and identifying those who need additional vaccines.

A pro tip from PSA’s resident policy expert Peter Guthrey MPS: think about all the  information you want to know before attending the webinar. The Q&A session will stay live until all questions have been answered.