3 November Third Dose Vaccine Pricing Framework

All District Health Boards 3 November 2021 Dear PHO Chief Executive Officers

Third Primary COVID-19 Vaccine Dose Pricing for Severely Immunocompromised Patients This letter provides PHOs with advice and key messages regarding the Government’s recent announcement that a third primary dose of the Pfizer/BioNTech COVID-19 vaccine will be available for severely immunocompromised patients. This should be read in conjunction with the attached algorithm and the broader COVID-19 Assessment Framework.

For general practice, this service will be accessed through a consultation with a General Practitioner or Nurse Practitioner who needs to assess the patient and issue a prescription if clinically indicated. This is intended as a temporary solution only. It will remain in place until such time that the use of a third primary Pfizer dose has been approved by Medsafe for use with severely immunocompromised patients.

Virtual consultations will be subsidised at $60 each, while in-person consultations will be subsidised at $120. This is a fully subsidised service. All guidance issued by the Ministry of Health must be followed, including obtaining a signed consent form. The claiming conditions for this service requires there is: •

no charge/patient co-payment for this service, including issuing the prescription

•

no claim for a GMS clawback

•

no simultaneous claim against any other funding stream for this service.

General Practitioners or Nurse Practitioners may proactively contact patients to discuss their potential eligibility for the third primary dose. Patients may also present believing they are eligible for the third primary dose. If these discussions are within the context of a clinical consultation and determine the patient is not eligible then a $60 fee can be claimed. This sum reflects that there will be no need to execute the consenting and prescription processes.

Some eligible patients may initially decline the third primary dose. That consultation will be funded at $60. If the patient later reconsiders and decides to receive their third primary dose, then the subsequent consultation subsidy will apply at the $60 virtual or $120 in-person rates as outlined above.

DHBs will manage the payments via variation to their existing contracts/agreements with PHOs and/or General Practices. This mechanism has previously been amended at pace to expedite newly identified payments for post vaccination event consultations and COVID-19 swabbing.

Key messages General Messages • •

• •

The COVID-19 Technical Advisory Group has recommended that individuals aged 12 and older with severe immunocompromise can receive a third primary dose of the Pfizer COVID-19 vaccine.

Individuals who are severely immunocompromised are at higher risk of severe outcomes from COVID-19 and might not produce a sufficiently strong immune response after two doses of the Pfizer COVID-19 vaccine. A third primary dose may be beneficial.

The third primary dose is optional but recommended.

There are specific criteria for who can qualify for a third primary dose.

All District Health Boards PO Box 23075 Wellington 6140

04 801 2430

• • • • •

The third primary dose is available by prescription only.

The third primary dose must be prescribed by a medical prescriber such as a GP or Specialist.

Scripts for a third primary dose are accepted at all vaccination clinics.

The third primary dose should be given at least 8 weeks after the second dose.

People with known severe immunocompromise from disease or its treatment are encouraged to contact their GP, NP or treating specialist to discuss the timing, prescription and administration of this additional dose of vaccine.

Booster Vaccines • • •

A primary third dose is different to a booster dose for the general population.

Under the current immunisation programme, people cannot receive a booster dose of the Pfizer vaccine in New Zealand unless they qualify under the criteria for a third primary dose.

The Ministry of Health is reviewing the research as it becomes available and they expect to make a decision about booster doses for the general public in the coming months.

Additional Messages • •

• • •

•

A prescription must be provided by a GP, NP or other specialist before people who are severely immunocompromised can access a third primary dose.

It is recommended that patients schedule an appointment with their usual health care professional who has access to their medical records and so they can confirm whether they qualify for a third primary dose.

Individuals might be able to receive the third primary dose at the same time as their consultation.

Individuals will need to check with their prescriber to see if they offer the Pfizer COVID-19 vaccine.

Appointments with a medical practitioner for a third primary dose are free.

It is strongly encouraged that all household contacts of someone who is severely immunocompromised (and over the age of 12) receive two doses of the Pfizer COVID-19 vaccine to help provide indirect protection.

Reactions reported after the third dose in small studies were similar to those after two doses, with fatigue and pain at injection site being the most commonly reported side effects, and overall, most side effects reported were mild to moderate.

Yours sincerely

Dr Nick Chamberlain Chief Executive, Northland District Health Board Lead District Health Board Chief Executive for Primary Care and Public Health cc:

GMs Planning and Funding, All DHBs Primary Care Portfolio Managers, All DHBs

Appendix 1: Algorithm

GP or NP contacts the patient

Patient contacts the practice Clinical Assessment: Is the patient clinically eligible?

Eligible patient reconsiders

No

Yes

$60 subsidy

$60 subsidy

Patient consents to the 3rd dose

No

Yes

Consent form signed and prescription issued

Type of consultation

Simple Virtual: $60 subsidy

Complex In-person: $120 subsidy