Clear bagging workflow implementation for post–hematopoietic stem cell transplant vaccinations

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ID: 316381
2026
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Ranked #128 of 143 articles by views in American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

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Abstract
Abstract 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.
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openalex_W7163866986 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Blas Aguero, YoungYoon Ham, Amber Diaz, Matthew Spinar, Pranesh Narayanaswami
Journal American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
Year 2026
DOI
10.1093/ajhp/zxag163
URL
https://doi.org/10.1093/ajhp/zxag163
Keywords Keywords not found

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