NCT06489964

Addressing Unfunded Vaccines Through a Co-payment Mechanism in Pharmacies

Addressing the Problem of Recommended But Unfunded Vaccines Through a Co-payment Mechanism in Pharmacies

• Status: Recruiting
• Phase: N/A
• Study type: Interventional
• Enrollment: 600 (estimated)
• Sponsor: Canadian Immunization Research Network · Network
• Sex: All
• Age: 2 Years
• Healthy volunteers: Accepted

Summary

The goal of this pilot demonstration and evaluation project is to determine the acceptability and feasibility of a co-payment model among the public and providers and assess whether a co-payment model in community pharmacies in Nova Scotia and Ontario increases the accessibility and uptake of recommended but unfunded vaccines. The research questions that guided the development of this study are: * What is the feasibility of implementing a co-payment model for recommended but unfunded vaccines in community pharmacies? * To what extent is a co-payment model for recommended but unfunded vaccines perceived as acceptable to community pharmacists and the public? A co-payment model will be piloted at a maximum of 8 select community pharmacy sites in Nova Scotia (n=4 sites) and Ontario (n=4 sites). Each community pharmacy site will be randomly assigned to pilot one of the steps of the co-payment model for the duration of the demonstration project. At the end of the pilot study, participating pharmacy providers will be asked to complete an online survey about their experiences in implementing the co-payment model into their pharmacy. As part of the co-payment model, recruited members of the public (participants) will choose to receive the vaccine (if eligible) at a reduced cost either for themselves or their dependent (e.g., incapable minor or adult), as part of routine care (following standard pharmacy practice). After receiving the vaccine, the participant will complete an online survey exploring their thoughts on the co-payment model, their satisfaction with the co-payment model, their perception on vaccines in general, and their demographics (such as gender, age, education, race/ethnicity).

Detailed description

While the National Advisory Committee on Immunization (NACI) provides vaccine recommendations, it is the responsibility of provinces and territories in Canada to decide which vaccine programs they will support and implement publicly. Some vaccines recommended by NACI are not publicly funded in Canada and require out-of-pocket pay or private health insurance plans. This lack of public funding may be a factor contributing to low vaccine uptake. Cost-related barriers are also important concerns among prescribers who tend to be hesitant in recommending vaccines that are not publicly funded due to issues with patient affordability. Pharmacy professionals (in some jurisdictions) across Canada are increasingly taking a dominant role in administering certain publicly funded vaccines such as influenza and COVID-19. However, administration of other recommended and publicly funded immunizations have been limited in many jurisdictions, and pharmacy services providing unfunded vaccines are underutilized. Current publicly funded immunization programs have proven to be cost-effective for the health care system; however, assessing the economic impact of vaccines takes time, resulting in recommended vaccines not being funded for some or all individuals. This economic impact of the initial, upfront costs of introducing a vaccine program can be financially prohibitive, acting as a major barrier to having vaccinations covered through public funding. As a result, introducing a co-payment system for recommended but unfunded vaccines may help mitigate the perception that these vaccines are of lesser importance, especially if the government is covering a portion of the vaccine and administration fees. A flexible co-payment model, where the costs are shared between the patient or their private insurance and the government, until full funding becomes available, could potentially offer a solution to enhance immunization rates for these vaccines. In this Pilot Demonstration and Evaluation Project, the investigators propose to better understand potential solutions to cost-related barriers that limit uptake of recommended but unfunded vaccines, with alternative funding models being one possible solution. Implementation of a co-payment funding model within community pharmacies will be piloted at select community pharmacies in Nova Scotia and Ontario where pharmacy providers will prescribe and administer recommended but unfunded vaccines, as part of routine care. Electronic surveys will assess public and provider satisfaction with the model and the number of people vaccinated before and during the pilot demonstration will be compared.

Conditions

• Preventable Disease, Vaccine

Interventions

Type	Name	Description
OTHER	Co-payment Model - Step 1	Step 1 of the co-payment model: A pharmacy site from Nova Scotia and Ontario will be randomly assigned to this step where the study will cover the administration service fee (approximately $35.00) and the participant will pay 100% of the vaccine cost out-of-pocket for the eligible vaccine. The vaccines will include FluMist Quadrivalent, Shingrix, and Abrysvo or Arexvy.
OTHER	Co-payment Model - Step 2	Step 2 of the co-payment model: A pharmacy site from Nova Scotia and Ontario will be randomly assigned to this step where the study will cover 50% of the vaccine cost plus the administration service fee and the participant will pay 50% of the vaccine cost out-of-pocket. The vaccines will include FluMist Quadrivalent, Shingrix, Abrysvo or Arexvy.
OTHER	Co-payment Model - Step 3	Step 3 of the co-payment model: A pharmacy site from Nova Scotia and Ontario will be randomly assigned to this step where the study will cover 75% of the vaccine cost plus the administration service fee and the participant will pay 25% of the vaccine cost out-of-pocket. The vaccines will include FluMist Quadrivalent, Shingrix, and Abrysvo or Arexvy.
OTHER	Co-payment Model - Step 4	Step 4 of the co-payment model: A pharmacy site from Nova Scotia and Ontario will be randomly assigned to this step where the study will cover 100% of the vaccine cost plus the administration service fee and the participant will pay 0% of the vaccine cost. The vaccines will include FluMist Quadrivalent, Shingrix, and Abrysvo or Arexvy.

Timeline

• Start date: 2025-10-23
• Primary completion: 2026-12-01
• Completion: 2026-12-01
• First posted: 2024-07-08
• Last updated: 2026-03-19

Locations

2 sites across 1 country: Canada