Changes You Should Know about the Adult Pneumococcal Vaccination

The Centers for Disease Control and Prevention (CDC) has broadened vaccination recommendations, and a new adult pneumococcal vaccine has entered the market. These changes introduce additional nuances when selecting the appropriate vaccine for each patient.

Expanded Vaccination Recommendations

The CDC now recommends pneumococcal vaccination for adults ages 50 and older, which is a change from the previous recommendation for adults ages 65 and older. Vaccination for adults ages 19 to 49 remains recommended for those with risk factors or immunocompromising conditions.

A New Vaccine is Available: PCV21 (Capvaxive)

PCV21 (Capvaxive) has recently been approved and offers broader protection than the existing PCV20 (Prevnar 20) vaccine – it covers 10 of the same serotypes and an additional 11 serotypes. These include eight serotypes not found in any other vaccine, which contribute to 30% of invasive disease in patients ages 50 and older. All this translates to improved coverage of invasive pneumococcal disease (77-85% with PCV21 versus 54-65% with PCV20). However, it's crucial to note that PCV21 does not cover serotype 4, which is covered by PCV20 and PCV15 and is a significant cause of invasive disease in the Western U.S.

Choosing the Right Vaccine

Selecting the appropriate vaccine can seem complex, but the CDC’s Pneumo Recs VaxAdvisor App and website offer helpful guidance. Here's a simplified guide:

• PCV21: Suitable for most adult patients ages 18 and older. Offers superior overall serotype coverage. One dose will get patients up to date.*
• PCV20: Appropriate for most children and adults. Remains a valuable option that covers serotype 4. One dose will get patients up to date.*
• PCV15 (Vaxneuvance): Another option for vaccine-naïve patients, but typically requires a second dose with PPSV23 (Pneumovax23) a year later.

*This includes patients:

• With no prior pneumococcal vaccination.
• Previously vaccinated with PPSV23 or PCV13. Generally, a one-year waiting period after PPSV23 or PCV13 is recommended before administering PCV20 or PCV21.
• Who received PCV13 and PPSV23 before age 65 may require PCV20 or PCV21 after 5 years; if PPSV23 was administered at age 65 or older, a risk/benefit assessment should be considered.

Highmark Wholecare Coverage of Pneumococcal Vaccines

• Pennsylvania Medicaid: Covered at the pharmacy or provider office without restriction for members ages 19 years and older with a $0 copay. Members ages 18 and under should be vaccinated through the Vaccines for Children program.
• Pennsylvania Medicare D-SNP: Covered under Part B with no coinsurance. Administration at a physician's office or a Medicare Part B-participating pharmacy is permitted.

We encourage you to track these updates, so you can ensure your patients receive the most appropriate and effective pneumococcal vaccination. We are here to support you in providing your patients vital, optimal care.