Newsletter October 2021

BREAKING: CDC panel recommends COVID-19 boosters for long-term care residents

Danielle Brown

Long-term care residents are one step closer to receiving Pfizer’s COVID-19 booster shots after an advisory panel affiliated with the Centers for Disease Control and Prevention approved a key recommendation Thursday. 

The CDC’s Advisory Committee on Immunization Practices recommended booster doses of the Pfizer COVID-19 vaccine for select adult populations, including residents living in long-term care facilities and seniors aged 65 and older. 

The third dose is only available for those who were initially vaccinated with the Pfizer vaccine, not Moderna or Johnson & Johnson. Moderna has submitted data to federal health officials on its own booster shot. 

The committee’s recommendation now will head to CDC Director Dr. Rochelle Walensky for final approval. Shots can begin being administered immediately if she approves the recommendations. 

The panel also recommended that people ages 50 to 64 with underlying medical conditions receive a third dose, and for adults ages 18 to 49 with underlying medical conditions. The advisory group however did not extend that recommendation to people who work in high-risk settings for COVID-19 transmission. 

The approval came a day after the Food and Drug Administration authorized the single booster dose of the Pfizer vaccine for older adults and high-risk patients six months after receiving their second shot.


FDA approval of COVID-19 vaccine not enough to convince hesitant caregivers to roll up their sleeves

Kimberly Bonvissuto


The Food and Drug Administration’s full approval of the Pfizer–BioNTech COVID-19 vaccine has done little to instill confidence in vaccine safety and effectiveness for unvaccinated caregivers, according to the results of a new survey. and Pollfish survey of 2,000 caregivers — 1,000 professional and 1,000 unpaid — found that one in three (31%) unvaccinated caregivers, overall, say they will refuse the shot, now marketed under the brand name Comirnaty — up from 19% prior to full FDA approval. Of professional caregivers, 28.4% reported they would refuse the shot indefinitely, up from 22.2% in the prior survey. 

Overall, professional caregivers reported slightly less hesitation than unpaid caregivers in getting vaccinated, but that hesitation actually increased after the FDA’s announcement. The study contrasts responses from caregivers three days after the FDA’s announcement with responses to the same survey conducted 10 days before the announcement.

The bottom line is, full FDA approval did not motivate caregivers to take steps toward vaccination.

“While it’s expected that the FDA’s full approval of the Pfizer vaccine would take more time to increase the number of fully vaccinated caregivers, the fact that it has not motivated caregivers to take concrete steps towards full vaccination is concerning,” according to a report on the survey. “Overall, there is no substantial shift in the number of fully vaccinated, partially vaccinated or unvaccinated caregivers between the survey completed before the FDA’s announcement and the survey completed afterward.”

Although lack of full approval of vaccines was the main reason for caregivers doubting its safety, more caregivers turned against the vaccine and actually are less trusting of its safety after full FDA approval, according to survey responses.

Overall, 35% of vaccine-hesitant paid and unpaid caregivers now say they have concerns about the safety and testng of the COVID-19 vaccines, up from 29% before the announcement. When it comes to professional caregivers, 28.4% reported that they have concerns about safety and testing of vaccines, up from 20.8% in the prior survey.

“Counterintuitively, more caregivers are saying they distrust the safety and effectiveness of the COVID vaccines now than prior to the FDA’s full approval of the Pfizer vaccine — 20% more doubt the safety of the COVID vaccines, while 13% more now doubt their effectiveness,” a report on the survey stated. “Additionally, more caregivers also list a general distrust of vaccines as a reason for remaining unvaccinated.”

More than half of vaccine-hesitant paid and unpaid caregivers still say they would rather lose their jobs than get a shot under an employer vaccine mandate. When it comes to mandates, not a lot has changed from the prior survey; for professional caregivers, the number of undecideds on vaccination when required rose from 22% to 26%, whereas the number who said they would get the vaccine dropped from 26% to 22%. 

“Based on this data, mandates may be the only remaining step that will significantly impact caregivers’ decision to get the shot,” the report stated.

The survey also revealed that participating paid and unpaid caregivers now are more willing to believe that COVID-19 is a hoax. Survey results showed that more than one in 10 caregivers still believe COVID-19 is a hoax and not an actual health crisis. The percentage of professional caregivers who said that coronavirus is a hoax or not a crisis (12% and 8.2%, respectively) in the latest survey remained unchanged from the prior survey.



CCRCs challenged by caregiver turnover, but nursing homes have it worse: report

Kimberly Bonvissuto

 Turnover rates for certified nursing assistants, licensed practical nurses and registered nurses in continuing care retirement communities have reached their highest points over the past decade in 2021, according to a new analysis of historical data from the Hospital & Healthcare Compensation Service.

But the rates in nursing homes were still higher, HCS said.

Among the three positions in CCRCs, CNAs had the highest turnover rate in 2021, at 45.87%, but the rate was 51.38% in nursing homes, according to the 2021-2022 Continuing Care Retirement Community Salary & Benefits and Nursing Homes Salary & Benefits reports.

For LPNs, the 2021 turnover rate was 36.81% in CCRCs, compared with 37.67% for nursing homes. For RNs, the 2021 turnover rate was 40.45% in CCRCs, compared with 41.06% in nursing homes.

For CNAs, turnover was at its lowest point over the past decade in CCRCs in 2013, when the rate was 30.31%, and in nursing homes in 2014, when the rate was 30.15%.

In fact, 2014 marked the low point for turnover over the past decade for both LPNs and RNs in both CCRCs and nursing homes.

For LPNs, 2014 saw a turnover rate of 24.89% in CCRCs, but the rate was higher, 25.18%, in nursing homes.

For RNs, the 2014 turnover rate was 25.55% in CCRCs, but it was higher, 27.55%, in nursing homes. 

The CCRC and nursing home reports can be ordered on the HCS website. The CCRC report is published in cooperation with LeadingAge. The nursing home report is supported by the American Health Care Association and published in cooperation with LeadingAge.



How to Address Customer Concerns Regarding Uncovered Prescriptions in the Pharmacy Setting

Hossam Maksoud, PharmD

Since pharmacy is a service business, the required process of communicating and educating customers, working closely with physicians, and navigating relief programs can help patients customers address the problems and stress of receiving a denial by their insurance company.

More than one-third of adults reported that their health insurance plan would not cover a drug prescribed by their physician over the past year, according to an NPR poll.1 Upon learning of an insurance company’s denial of coverage for a medication, the patient may become stressed and may also be surprised by this occurrence, leading them to potentially take out their anger on the pharmacist or pharmacy staff they are speaking to.

In this situation, the first step a pharmacist should take is to address the customer’s expectations, which may be based on a lack of information. Many patients may expect that they will receive the drug their doctor prescribes without any complications, and that their insurance will cover the cost of the drug with no obstacles. But more often than not, that isn’t how it works at all.

It is important to educate patients that insurance companies typically have formulary drugs, both generic and brand-name. Within their formulary, insurance companies will have both preferred and non-preferred lists, which will have different co-payment requirements. Once the patient understands this, it is possible to work with them and the physician to assess the best way to proceed.

If there is an alternative drug within the same therapeutic class that would be covered by the customer’s insurance, it is possible to call the physician to suggest it. In many cases, the doctor may decide to try the alternative drug.

However, there may be cases in which the physician may say the patient needs the uncovered drug—perhaps the formulary alternative drug was previously prescribed and did not produce the desired result. Whatever the conversation and decision by the physician may be, the pharmacist is the one who will need to be able to communicate this information to the patient because it is crucial to keep the patient in the loop regarding their health care protocol and requirements.

Additionally, it may be beneficial to work alongside the physician’s office to initiate the prior authorization process to impress upon the insurance company that the drug in question is medically necessary. For pharmacists, making sure the prior authorization process keeps moving along is important as well.

As pharmacists know, prior authorization is not a simple process and it is not uniform across insurance companies. Some companies require more documentation than others and it is a pharmacist’s job to invest in staff who will spend the time to follow up with the insurance company.

This task it vital to find out what else is required and whether there is anything outstanding to coordinate with the physician’s office and ensure the missing documents are submitted in a timely manner. If the prior authorization process is completed and the drug is still denied, it may be necessary to discuss with the physician and the patient whether they want to go through the appeal process.

Naturally, prior authorization takes time—usually several days, at least—and during this time the patient will not be able to take their prescribed medication. As a pharmacist, it may be necessary to opt to let the patient pay out of pocket for 2- or 3-days’ worth of medication while waiting for the decision.

In many instances, this option may not be feasible, such as with inhalation, topical, or ophthalmic drugs or injectables. Some pharmacies may also dispense a couple days’ worth of medication at no charge until the prior authorization is granted, but they run the risk of incurring costs if they get a denial.

This is a risk that some pharmacies are willing to take to ensure their patients are happy and healthy. However, it also can be possible to approach this situation by convincing the insurance company to authorize an emergency supply of a few days’ worth of drugs while the decision is pending.

Sometimes drugs are covered, but at a high out-of-pocket cost to patients. When patients are on maintenance drugs that cost $75 per month, for example, this is not a sustainable cost for many patients. At Community Care’s specialty pharmacy division, we provide specialty drugs in several categories, including rheumatology, dermatology, osteoarthritis, and hepatitis, and many of these drugs have high out-of-pocket costs.

As a pharmacist, it is important to educate patients about the process for obtaining a specialty drug. Many of these medications have no substitutes or alternatives and almost all have high co-pays.

Customers should not hesitate to let their physician know when drugs are beyond their reach in terms of expenses. With specialty drugs, the prior authorization process requires much more documentation and may take longer to complete. In addition, some of these medications will have limited distribution, whereby the drug can only be dispensed by a few particular pharmacies nationwide.

When it comes to cost or co-pays, there are nonprofit organizations that assist low-income individuals with medication expenses. Many biopharmaceutical companies have been expanding their cost-sharing programs in which they help cover out-of-pocket expenses for patients who cannot afford their medications. In addition, some manufacturers offer free trials, which may be a more affordable option for patients.

Furthermore, patients with high out-of-pocket expenses may also realize significant savings by enrolling in a prescription discount card program. As a pharmacist, it may be beneficial to proactively look for coupons and assistance programs and navigate through them for patients to provide the support they may not be able to get anywhere else.

Since pharmacy is, at its heart, a service business, the required process of communicating and educating customers, working closely with physicians, and navigating relief programs offered by manufacturers and nonprofit organizations may help to provide customers with the solutions they need to address the problems and stress of receiving a denial by their insurance company for drugs they may need to maintain their health.

About the Author

Hossam Maksoud is CEO and founder of Community Care Rx, a unique long-term-care pharmacy based in Hempstead, NY, that provides comprehensive pharmacy services to various types of organizations.

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