According to an abstract presented at ACR Convergence and published in Arthritis & Rheumatology, a quality improvement initiative leveraging specialty pharmacy services significantly improved recombinant zoster vaccine (RZV) uptake among immunocompromised adults under 50 with rheumatoid arthritis (RA), a group traditionally under-vaccinated despite guideline recommendations. The partnership focused on aligning vaccine delivery with routine rheumatology visits to reduce access barriers and enhance adherence.

“Despite guideline recommendations, recombinant zoster vaccine (RZV) uptake remains low among immunocompromised individuals younger than 50 years of age, notably those with rheumatoid arthritis (RA),” the authors wrote. “Our aim was to increase RZV uptake among RA patients ages 18-49 from 10% to 15% by January 2025 through a targeted partnership with specialty pharmacy.”

The baseline cohort included 137 RA patients aged 18–49 seen at a tertiary care clinic between July and December 2023. Previous education-focused interventions had raised uptake from 6.7% to 10.3% by May 2024. A root cause analysis identified vaccine access as a persistent barrier.

Beginning in June 2024, the clinic launched a collaboration with Stanford Specialty Pharmacy, located near the rheumatology clinic, to streamline vaccine access. The intervention included:

• Pre-visit vaccine counseling by pharmacists

• Coordination of prior authorization and prescriptions

• RZV administration on the day of the rheumatology appointment

• Validated parking for improved clinic access

• A follow-up workflow for scheduling the second vaccine dose between 2–6 months post-initial dose

Key Results:

• Primary outcome met: RZV uptake increased to 15.3% between June 2024 and January 2025

• Dose series completion: By May 2025, 5 of 9 eligible patients (55.5%) had completed the two-dose series

• Common barriers:

  • Reproductive considerations (n=5) – including pregnancy, IVF, breastfeeding

  • Insurance authorization delays (n=5)

  • Vaccine hesitancy (n=3)

“A targeted partnership with specialty pharmacy significantly improved RZV uptake among RA patients ages 18-49 years, which included direct outreach to the patients from the pharmacists,” the authors concluded.

The success of this initiative highlights the potential of multidisciplinary, logistics-focused interventions—especially those integrating pharmacy outreach, appointment-aligned vaccine delivery, and streamlined insurance processes—to overcome known vaccination barriers in high-risk populations.

Before broader implementation across rheumatologic populations, future efforts should tailor solutions to condition-specific needs and expand access strategies for patients navigating reproductive health, insurance hurdles, or vaccine hesitancy.

Reference
Sood A, Davuluri S, Haidar S, et al. Improving recombinant zoster vaccine uptake in younger adults with rheumatoid arthritis through a partnership with specialty pharmacy [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/improving-recombinant-zoster-vaccine-uptake-in-younger-adults-with-rheumatoid-arthritis-through-a-partnership-with-specialty-pharmacy/
 Accessed October 15, 2025.