American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists · 2026
Clear bagging workflow implementation for post-hematopoietic stem cell transplant vaccinations.
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Aguero Blas, Ham YoungYoon, Diaz Amber, Spinar Matthew, Narayanaswami Pranesh
Аннотация
PURPOSE: To describe development and implementation of a "clear bagging" workflow to improve coordination of vaccinations after hematopoietic stem cell transplantation (HSCT) while maintaining clinic-based administration and reimbursement.
SUMMARY: Vaccines administered during clinic visits are often billed through medical insurance using a buy-and-bill model, which can result in patient claim denials and subsequent institutional write-offs, particularly for Medicare beneficiaries. To address this, health systems have adopted alternative distribution models such as clear bagging, whereby an internal pharmacy dispenses medication for on-site administration, supporting care coordination and reimbursement retention. At Oregon Health & Science University (OHSU), patients receiving HSCT complete a 24-month posttransplant vaccination protocol at an ambulatory oncology clinic. To address challenges associated with medical billing for these vaccines, a clear bagging workflow for post-HSCT vaccinations was implemented to route vaccine dispensing through an internal outpatient pharmacy while maintaining clinic-based administration. The implementation leveraged an existing post-HSCT vaccination protocol within the electronic health record (EHR) by incorporating electronic prescriptions that are routed by default to an OHSU outpatient pharmacy. A dedicated outpatient pharmacy work queue captured vaccine prescriptions originating from the EHR protocol, ensuring efficient identification and prioritization for dispensing. Implementation established a standardized workflow for vaccine distribution, documentation, and billing. Over the first 10 weeks after workflow implementation, 173 vaccine prescriptions were processed through the clear bagging workflow. Projected increased reimbursement was $1,655 per Medicare patient completing the 24-month post-HSCT vaccination protocol.
CONCLUSION: This report demonstrates that clear bagging can be an effective model for vaccine delivery in oncology populations, reducing administrative burden while supporting both patient care and institutional protocols.
SUMMARY: Vaccines administered during clinic visits are often billed through medical insurance using a buy-and-bill model, which can result in patient claim denials and subsequent institutional write-offs, particularly for Medicare beneficiaries. To address this, health systems have adopted alternative distribution models such as clear bagging, whereby an internal pharmacy dispenses medication for on-site administration, supporting care coordination and reimbursement retention. At Oregon Health & Science University (OHSU), patients receiving HSCT complete a 24-month posttransplant vaccination protocol at an ambulatory oncology clinic. To address challenges associated with medical billing for these vaccines, a clear bagging workflow for post-HSCT vaccinations was implemented to route vaccine dispensing through an internal outpatient pharmacy while maintaining clinic-based administration. The implementation leveraged an existing post-HSCT vaccination protocol within the electronic health record (EHR) by incorporating electronic prescriptions that are routed by default to an OHSU outpatient pharmacy. A dedicated outpatient pharmacy work queue captured vaccine prescriptions originating from the EHR protocol, ensuring efficient identification and prioritization for dispensing. Implementation established a standardized workflow for vaccine distribution, documentation, and billing. Over the first 10 weeks after workflow implementation, 173 vaccine prescriptions were processed through the clear bagging workflow. Projected increased reimbursement was $1,655 per Medicare patient completing the 24-month post-HSCT vaccination protocol.
CONCLUSION: This report demonstrates that clear bagging can be an effective model for vaccine delivery in oncology populations, reducing administrative burden while supporting both patient care and institutional protocols.