Vaccines that are approved for use by the Food and Drug Administration are then reviewed by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, which decides whether to recommend the vaccine to the general population and/or certain groups of interest. ACIP can make several different types of vaccine recommendations: “routine,” “catch-up,” “risk-based” or “shared clinical decision-making.”
For routine, catch-up and risk-based recommendations, vaccines are recommended for all individuals within a certain group. However, for vaccines that are recommended based on shared clinical decision-making, there is no default decision about who should receive the vaccine. Instead, patients and health care providers should discuss and decide together whether the patient would benefit from vaccination. This decision should be based on the individual’s health conditions and characteristics, the epidemiological evidence surrounding who may benefit most from vaccination and the health care provider’s clinical discretion.
What vaccines are recommended under shared clinical decision-making?
Vaccines administered via shared clinical decision-making include:
- Meningococcal B (MenB) vaccination for individuals 16-23 years old.
- Hepatitis B (HepB) vaccination for adults 60 years and older with diabetes.
- Human papillomavirus (HPV) vaccination for adults 27-45 years old.
- Pneumococcal conjugate vaccine (PCV20) for adults 65 years and older who have already completed recommended pneumococcal vaccination with both PCV13 and PPSV23, if PPSV23 was administered at 65 years or older.
How is shared clinical decision-making done?
There is no set of specific questions or procedures outlined by CDC to enforce shared clinical decision-making. The process of shared clinical decision-making should be based on the individual patient’s characteristics and risk factors. The goal is a high-quality discussion between the patient and the provider, supported by provider guidance and expertise. Sometimes, the conversation may be ongoing over several different visits or interactions with different providers. An example of a conversation starter that a provider may use with a patient is: “What have you heard about [condition]? Or “Let’s go over your options.”
Are vaccines recommended under shared clinical decision-making still covered by insurance?
Yes, shared clinical decision-making should not affect insurance claims. These vaccines are still considered “recommended” under the Affordable Care Act for all who receive them under shared clinical decision-making, meaning that they are required to be covered under most private insurance providers, as well as Medicare or Medicaid.
What resources are there to assist providers with shared clinical decision-making discussions?
CDC has several vaccine-specific resources available to assist providers with discussions about shared clinical decision-making: