This page last updated on 09/21/2023 at 17:30.

*The prescription requirement for pharmacist-administered vaccines in New York is handled in one of two ways.
Either:

• A) The pharmacist issues a patient-specific prescription pursuant to a non-patient-specific standing order issued by a collaborating provider, OR
• B) The patient obtains a patient-specific prescription written by their own provider, which is then administered by the pharmacist.

Riverside Remedies currently does not have a non-patient-specific standing order to administer the vaccines indicated above, which is why a prescription written by your primary care provider is necessary for us to administer those vaccines.  If your provider declines to issue you a prescription on the grounds that it is not necessary, simply explain that we do not have a standing order for the vaccine in question and/or refer them to this page for more information.

In short, a prescription is always required; the difference is who is able to write it.

News and Updates

21 September 2023:
We cannot reliably estimate exactly when we will be able to purchase COVID-19 vaccines.
Demand is extremely high, and most chain pharmacies are allotted supply preferentially over independent pharmacies.
We understand that hearing “I don’t know” is frustrating, but sometimes it is the only answer we have.
We will begin purchasing limited quantities of the Moderna vaccine when it becomes available for us to purchase from our wholesalers.

12 September 2023:
The FDA approved and authorized updated mRNA COVID-19 vaccines manufactured by Moderna and Pfizer for the 2023-2024 season; the new vaccines are monovalent, containing a single component corresponding to Omicron variant XBB.1.5.

Individuals aged 5 and older may receive one dose of the updated vaccine, provided at least two months have elapsed since the last dose of any COVID-19 vaccine.
Those younger than 5 years of age and unvaccinated individuals may receive multiple doses to “catch up,” according to the updated mRNA vaccine administration schedule.

OF PARTICULAR NOTE: the government-funded supply of COVID-19 vaccines is winding down and providers must now purchase their vaccines just like any other drug product.
As of September 12th, the initial wholesale pricing for the Moderna and Pfizer vaccines are approximately $1,295.00 and $1,200.00 for ten doses, respectively.
If this pricing is accurate, it will almost certainly end our ability to offer walk-in administrations with the speed and efficiency of previous years.

The reason why comes down to how insurance companies reimburse pharmacies.  This is the same reason why we stock so few brand-name drugs – if you’ve ever been curious about that, read on.

Pharmacies purchase drugs and vaccines from various drug wholesalers, and our terms are generally net-15 pricing. Each day’s order is added to an account, and that account is paid up in full every 15 days.  For example: say you receive a prescription for Saxenda (our cost to purchase is approximately $1,500 for a one-month supply).  If we were to order it for you today (September 12th), it’s cost would be added to our account and we would have to pay for it in full on September 25th.

However – insurance companies are much slower to remit payment for the drugs we dispense. It takes an average of six to eight weeks for your insurance company to reimburse us for any given prescription from the date it was dispensed.  Thus, by the time December arrives, we may have purchased and refilled your Saxenda three times (around $4,500 for us) but have only received reimbursement for the first fill (about $1,350; brand drugs are almost always reimbursed for less than cost).  This method is not ideal and illustrates quite well one of the many problems with our healthcare system, but it is the way it is and at least sustainable up to a point – provided everyone in town doesn’t start taking Saxenda all at once.

Now, consider the case of COVID-19 vaccinations.  Last fall we administered approximately 2,000 COVID-19 booster doses.  Fortunately, the Feds negotiated with Pfizer and Moderna at the beginning of the pandemic to purchase extremely large stockpiles of vaccines in exchange for a reasonable per-dose cost (around $12 each) and distributed them to providers for mass administration at no cost.  We were able to request as many vaccines as we needed – as long as they were administered quickly and efficiently.

This year, if we assume the demand for COVID-19 vaccines this fall is conservatively 75% of last year’s demand, our budget would need to sustain and front an increase of approximately $200,000 right now, and we would not begin to be reimbursed for the first doses administered until at least the end of October.  

The new RSV vaccine presents a similar scenario, with each ten-dose carton costing just under $3,000.  
Standard-dose influenza vaccines are approximately $200 per carton, and senior-dose influenza vaccines are well above $500 per carton.
If everyone interested in a dose of a COVID-19 vaccine is also seeking RSV and influenza vaccines, our total vaccine layout for September and October increases to $680,000.

Rest assured, we do intend to procure and administer the new Moderna and RSV vaccines when they become available.
We expect that most insurance companies will set copayments for any vaccine at zero out-of-pocket cost to you.
We would just ask for your patience and understanding when considering the financial burden these vaccines will place on this enterprise.  
We will make every effort to administer any of these vaccines to anyone who wants one – it just might not be as quick and easy as it used to be.

And finally: the COVID-19 vaccines prices quoted above are, at this time, estimates.  Neither vaccine is available to purchase today, and the actual prices may be significantly lower.  More information on this point will be published as it becomes available.  Check back frequently over the next several weeks for more updates.

15 June 2023:
The FDA’s Vaccines and Related Biological Advisory Committee (VRBPAC) met to discuss and make recommendations for SARS_CoV-2 strains for updated COVID-19 vaccines for use in the United States beginning in the fall of 2023.  The FDA anticipates assessing SARS-CoV-2 evolution at least annually (reviewing data each spring and convening the VRBPAC each June) to make ongoing recommendations for vaccine strain composition.
This process is similar to the one used annually for many years in developing each year’s influenza vaccine formula: data collected during peak seasons abroad and around the world is used to predict the dominant strains and fine-tune the vaccine for maximum efficacy.  However, it’s important to note that the underlying architecture of the vaccine cannot change without undergoing the much lengthier approval process required for new vaccines – the specific antigen cocktail is the only component that actually changes year-to-year.

Based on our experience with the availability of seasonal influenza vaccines every year, the following factors will likely hamper our ability to administer seasonal COVID-19 vaccines with the speed and precision of previous years:

• Data review and antigen selection take time, and mass production cannot begin until those details are finalized by the FDA (generally by late summer).  Thus, millions of doses must be manufactured, packaged, and distributed within a very short timescale.
• While annual influenza vaccine production is handled by approximately half a dozen pharmaceutical companies, only two companies (Moderna and Pfizer) are expected to handle the vast majority of COVID-19 vaccine production.  Fewer production companies = greater susceptibility to shortages, manufacturing delays, recalls, etc.
• The Federal government is not anticipated to purchase and distribute COVID-19 vaccines going forward (at least, not at the scale seen in previous years), which would then require providers to purchase and stock the vaccines with their own funds (as is the case with all other vaccines).  The budgetary constraints to purchase these vaccines will be the limiting factor for how many individuals we can vaccinate in a given period of time.
• Related to the previous point – large chain pharmacies will likely receive their stock well before any independents do.  Our influenza vaccines typically arrive in October, and we are anticipating similar supply and demand problems with seasonal COVID-19 vaccines.

21 April 2023:
The NYS Department of Health has authorized providers to commence operating on the new ACIP guidelines for second bivalent booster doses.

19 April 2023:
The CDC’s Advisory Committee on Immunization Practices (ACIP) has agreed to accept the FDA’s recommendations regarding changes to COVID-19 vaccine administration and eligibility.
These changes are explained in greater detail below.

19 April 2023:
The FDA authorized certain individuals to receive a second bivalent COVID-19 booster dose on Tuesday, April 18th.

18 January 2023:
The FDA has extended the expiration date for most lots of Paxlovid, including our current inventory (lot 2692131).
The original expiration date was 2023-03 (March 31st of 2023; pharmaceuticals always expire on the last of the month if a specific day is not indicated).
The new expiration date for this lot is now November 30th, 2023.

COVID-19 Vaccine

Still under construction – read the September 12th update above for more information.

Administration will likely be by appointment only.

Additional instructions will be added where when we have a better ETA on supply.

Influenza Vaccine

Quadrivalent influenza vaccines contain antigens to protect against two influenza A strains, and two influenza B strains.

Our current vaccine flavor is standard-dose Fluzone Quadrivalent, containing the following viral lineages:

• (A) Victoria/4897/2022
• (A) Darwin/9/2021
• (B) Phuket/3073/2013
• (B) Michigan/01/2021

As in previous years, we will not be purchasing or administering any high-dose or adjuvanted influenza vaccines due to the unfavorable cost/benefit ratio with purchasing these vaccines.

Our stance has always been, and remains, that consistent annual vaccination affords greater annual protection than any single dose, and that most individuals without preexisting immunocompromising or pulmonary disorders will be just fine with a standard dose.
Advertisements often portray the high-dose vaccines as necessary for all individuals aged 65 and older, but this is not necessarily the case – especially if you receive a dose annually.

If you feel that a high-dose vaccine is necessary, we recommend discussing and/or obtaining the vaccine from your physician.

Receiving an Influenza Vaccine:

Influenza vaccines are administered on a walk-in basis, Monday through Thursday every week, between 10:00 am and 5:00 pm.

No vaccines are administered on Fridays and Saturdays.

The minimum age for vaccination at Riverside Remedies is 5 years of age; there is no maximum age.

We would kindly appreciate if you would print out and complete the Influenza Vaccine Consent Form prior to your visit to avoid delays and keep things moving.

Shingrix Vaccine

Under construction.

Tetanus Vaccine

Under construction.

Pneumonia Vaccines

Under construction.

Respiratory Syncytial Virus (RSV) Vaccine

General information:

Taken from the FDA’s news release for the approval of Arexvy on May 3rd 2023:

“On May 3 2023, the FDA approved Arexvy, the first respiratory syncytial virus (RSV) vaccine approved for use in the United States. Arexvy is approved for the prevention of lower respiratory tract disease caused by RSV in individuals 60 years of age and older.
RSV is a highly contagious virus that causes infections of the lungs and breathing passages in individuals of all age groups.  RSV circulation is seasonal, typically starting during the fall and peaking in the winter.  In older adults, RSV is a common cause of lower respiratory tract disease (LRTD), which affects the lungs and can cause life-threatening pneumonia and bronchiolitis.  According to the U.S. Centers for Disease Control and Prevention, each year in the U.S., RSV leads to approximately 60,000-120,000 hospitalizations and 6,000-10,000 deaths among adults 65 years of age and older.”

The vaccine is administered as a single dose to individuals aged 60 years of age and older.

The side effect profile is largely similar to most other vaccines, except with a higher incidence of injection site pain due to the vaccine containing an adjuvant – an ingredient that helps elicit a stronger immune response against the pathogen.  Adjuvanted vaccines typically have somewhat higher rates of injection site pain as compared to non-adjuvanted vaccines, though such pain often  resolves within a few days.  Other adjuvanted vaccines include Fluad (one of the three influenza vaccine formulations designed for seniors), Shingrix (zoster/shingles), and most tetanus vaccines.

How to receive:

More detailed information for obtaining a dose will be added here when we begin administering the vaccine; available inventory will be added to the top of this page.

Administration will be offered by appointment only due to cost for us to purchase and maintain stock ($3,360 per carton of 10 doses).

ORAL ANTIVIRALS for COVID-19

The U.S. Department of Health and Human Services selected Riverside Remedies to provide oral antiviral medications for the treatment of mild-to-moderate COVID-19.

We were informed that the number of providers selected to participate is relatively limited, though we have no other indication at this time as to how many other local providers will also be offered these medications. All providers with antiviral stock are required to report daily inventory to a centralized database, so that prescribers will be able to find local stock quickly.

What medications are available?

Currently, two oral medications have received emergency use authorization by the FDA and CDC to treat mild-to-moderate COVID-19:

• Paxlovid, a combination drug consisting of:
  • Nirmatrelvir, a novel SARS-CoV-2 protease inhibitor that inhibits viral replication, and
  • Ritonavir, another antiviral that prevents the body from metabolizing the nirmatrelvir too quickly.
•  Lagevrio (molnupiravir), a single-entity nucleoside analog that prevents SARS-CoV-2 replication by mutagenesis.

Paxlovid is significantly more effective than Lagevrio, and is the preferred oral agent for acute infection. We do not stock Lagevrio.

How are the medications used?

Importantly, these medications can only be used for post-exposure treatment – they cannot be used for pre- or post-exposure prophylaxis for the prevention of COVID-19, nor as a substitute for vaccination.

They also cannot be used for severe disease that require hospitalization, in which case a patient would likely be administered a monoclonal antibody infusion (among other things).

These drugs are only intended to aid the patient in recovering at home from a mild-to-moderate infection, and to possibly help preventing a less serious case from progressing to a more serious one that may require hospitalization. They are analogous to Tamiflu in this way – they won’t prevent you from getting sick in the first place, but once confirmed may help you recover a little more quickly and comfortably.

How do I get an oral antiviral medication if I need one?

A prescription is required; any provider prescribing Paxlovid and Lagevrio should know the requirements to initiate therapy.

However, there are a few points that you can consider to ensure that we are able to dispense in a timely manner:

• A prescription for Paxlovid or Lagevrio must contain an ICD-10 code and date of positive COVID-19 test; make sure your prescriber includes both on the prescription.
• Therapy should be initiated as soon as possible – within five days of symptom onset, and preferably within 72 hours.
• Paxlovid has a lengthy list of potential drug interactions.  Proper interaction screening is critically important.
• If you are not a regular patient of ours, you must provide us with a list of any and all medications (prescriptions and over-the-counter) that you take.