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

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.

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.

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.