Why can't I get Gardasil at 27?

June 18, 2007 8:30 AM

Why can't I get Gardasil after I turn 27?

I'm pretty sure that somewhere before Gardasil came out, I read that the reason the upper age limit was set at 26 is because that is the age by which most women have lost their virginity. (Gardasil is given before you become sexually active, so that you don't catch HPV.)

I turn 27 next month, I have no insurance (and have been denied Medicaid twice) and there's no way in hell I can afford $130 per shot, for 3 shots. (I really can't even afford a payment plan, unless they'll take like $5 a month.) I'm a virgin. As long as I remain a virgin, can I still get the shot later on?

My general doctor and GYN seem to want to rush me to get the first shot before my birthday. As far as I can tell, though, there is no magic switch that flips the minute I turn 27, saying I can no longer get the vaccine. Is there any reason beyond virginity to not give Gardasil over that age? Will it be hard to find a doctor who will vaccinate me later on?

(FWIW, so there is no doubt - I'm not a "technical virgin" - the farthest I've gone with a guy is that I've been kissed on the cheek.)

posted by anonymous to health & fitness (22 comments total)

As far as I understand it, Gardasil can be adminstered whether you're sexually active or not. My doctor told me I was the ideal candidate for it when it first hit the market. I'd been diagnosed with HPV before (it has since gone away on its own, after doing the whole biopsy thing... very pleasant) and she obviously knew that when she told me about the vaccine. I'd get a second opinion if I were you (well, looks like you'll need a third).
Good luck!
posted by slyboots421 at 8:36 AM on June 18, 2007

I've heard, and this article states, that the age limit is in place because the vaccine has only been studied in people in that age range. It probably wouldn't hurt someone older than 26, but they don't have any data to say one way or the other.
posted by vytae at 8:40 AM on June 18, 2007

The vaccine was only tested on women under the age of 27. It was believed that women 27 and older were so likely to already have HPV, so cutting off at 26 meant they had a higher proportion of HPV-free volunteers in the study. There's no reason to believe that it won't work on women in their late 20s or that it is unsafe. But this hasn't been verified through clinical trials.

I'd imagine it wouldn't be any more difficult to find a physician to give you the vaccine if you were a few years older than it is now.
posted by grouse at 8:43 AM on June 18, 2007

My understanding is that if you initiate the series of shots after age 26, insurance companies are not obligated to cover the cost of the injections. So you can still get the shots after you turn 27, but you will likely have to pay for them out of pocket (same as now, since you don't have insurance).
posted by amro at 8:43 AM on June 18, 2007

You can, depending on your doctor.
posted by unknowncommand at 8:45 AM on June 18, 2007

Oh, and previously.
posted by amro at 8:45 AM on June 18, 2007

Basically if a doctor gives it to you outside of the approved age range the doctor is libel or at least potentially libel if something goes wrong. Basically you need to find a doctor that will risk that because they believe in the vaccine enough. It will still be effective your doctors just don't want to take the libel risk.

I listen to a bunch of Loveline and the doctor on that show has answered this quest maybe about ten times now. He's a huge fan of the vaccine and reconmends it all the time to people. As a result of that he gives calls about confused people asking why their doctor won't give it to them out side of the age range. I'm just relaying his answer.
posted by magikker at 9:17 AM on June 18, 2007

I started my Gardasil shots three months ago (I get my second one next week) and I went to my local health clinic where I got the shot for $10/each. I have health insurance but it would have only covered about $70/shot, so I called up the local community clinic and found out that they're offering them wicked cheap. Try calling the Job and Family Services in your area and see if they are offering discount shots.

As for the age, I heard the same thing that grouse said.
posted by banannafish at 9:20 AM on June 18, 2007

Basically if a doctor gives it to you outside of the approved age range the doctor is libel or at least potentially libel if something goes wrong. Basically you need to find a doctor that will risk that because they believe in the vaccine enough. It will still be effective your doctors just don't want to take the libel risk.

The word is "liable" and there is no magic line where off-label use automatically results in malpractice liability for the prescribing doctor. Dr. Drew is not a lawyer, but the author of that link is; take a look if you're genuinely curious about the legal implications of off-label prescriptions.
posted by rkent at 9:48 AM on June 18, 2007

Go to a planned parenthood or similar as banannafish suggests. They'll likely have it cheaper than a 'regular' doctor, and they will probably be more willing to 'bend the rules' about the age thing. Not because they go willy nilly breaking the law, but because they care about keeping sex safe.
posted by misanthropicsarah at 9:48 AM on June 18, 2007

There's nothing magic about 27, except that's the upper limit of the age range its been studied in and a real stickler of a doctor would refuse to administer it to you for liability issues and malpractice allegations if you were to experience adverse side effects. Some doctors are not sticklers--I'm getting the shot and am not a virgin.

If you want to try it cheaper, your local Planned Parenthood may be able to help you out. They have sliding-scale fees for this sort of thing for people without health insurance and low incomes (though you will have to provide proof). I don't know if they cover Gardasil but it's worth a shot (heh heh).

Dang! I wish I had thought to call up local clinics! I do have health insurance but they don't cover Gardasil at all (I guess they like cancer?), so I'm paying full price.
posted by schroedinger at 9:55 AM on June 18, 2007

rkent. From your link which was a very interesting read. Thanks for submitting it.

In short, off-label prescribing bears some inherent liability risk for the physician.

So, yes, In fact there is a magic line where there is some inherent liability risk. I guess that with this drug that line is at 27 years of age. It should be noted that this is a very small risk as pointed out by that article. But yes, there is some risk and I would guess that is why your doctors would much rather you take it now.
posted by magikker at 11:04 AM on June 18, 2007

Contact your local state-run health department clinic. Planned Parenthood would be my next alternative.

Health departments exist for this exact reason and your exact situation.
posted by Ynoxas at 11:09 AM on June 18, 2007

My girlfriend is 27 and is getting the shot. She was able to get a doctor to prescribe it to her, after the doc went through a parade of horribles about how terrible side effects could come up that no one knew about. It'll be more of a hassle, but it can be done.
posted by kingjoeshmoe at 11:18 AM on June 18, 2007

I got the first round of Gardasil when I was 28 from a university health service.
posted by pitseleh at 3:20 PM on June 18, 2007

Dammit, magikker, I should have known someone would scroll down and pull out that quote, which I duly read and posted the link anyway. Surely if you read that far down, you read the segment several paragraphs up stating: "it follows from the fact that off-label use is not illegal that using a product off-label does not by itself constitute malpractice." And surely you read my post that you are quoting which said that there is no magic line at which "off-label use automatically results in malpractice liability"?

And having read both of those items, you would surely not pull another quote that is logically consistent with both statements (themselves logically consistent with one another) as if to contradict either of them in an effort to score petty debate points? Because in addition to being plainly incorrect and a failure of reading skills, that would just be lame.
posted by rkent at 3:30 PM on June 18, 2007

Follow-up from the OP:

"I did try my health department - they won't give the discount to anyone over 18."
posted by jessamyn at 4:34 PM on June 18, 2007

Amazingly, my GYN (actually, she's an NP) told me that after age 27, a woman's body processes vaccines differently and therefore Gardasil won't "take effect" after a woman reaches that age. Even more amazingly, I sort of believed her (hah) for a while, until someone in a similar online forum called my attention to basic common sense.

Just to share the kind of information you may or may not get when inquiring about this.

Oy.
posted by AthenaPolias at 7:30 PM on June 18, 2007

There's a doctor in my town who is active in the gay community and is prescribing it (off-label) to men, so one would hope he might prescribe to women over 26 as well. I keep meaning to call his clinic. I read an article about him in the local gay and lesbian weekly. Perhaps there's something similar where you live?
posted by Violet Hour at 12:12 AM on June 19, 2007

Amazingly, my GYN (actually, she's an NP) told me that after age 27, a woman's body processes vaccines differently and therefore Gardasil won't "take effect" after a woman reaches that age. Even more amazingly, I sort of believed her (hah) for a while, until someone in a similar online forum called my attention to basic common sense.

Actually, your immune system does change as you age and the effect of the vaccines can decline as the age of administration increases. There is some evidence to suggest this here although it's not conclusive or complete. There isn't a magic line where the vaccine suddenly stops working, but the push to get it sooner rather than later has more reasoning than just malpractice or off-label use or whatever. So the 'common sense' call is, at best, ill informed.

Doctors simply don't know yet how much age-related changes in immunity will affect this particular vaccine's effect, and there is a real possibility that it really won't work when given to older women (and obviously a possibility that it will). Vaccines aren't a sure thing and can have greater or lesser effects, and age of recipient is a genuine factor in this stoichiometry.

Some research has indicated that this vaccine may have best effect in much younger females because of how the immune system is developing at that age and what happens to it after you become an adult, which is why there is a push to have it given at 10-12. Sadly politics and knee jerk reaction generally wins over scientific findings and it seems that it's being given much more widely than the original researchers suggested.

Personally I'd get it as young as possible if I was eligible as so far indications are that that will probably give you the best chance of gaining protection. If money is a real factor and you're only taking about waiting a year (and are already much older than 12), then waiting probably won't make a huge difference. I won't be getting it given I'm not a virgin and have a high chance of being exposed to HPV already (in which case it's too late), and am therefore not eligible anyway.
posted by shelleycat at 1:28 AM on June 19, 2007

I won't be getting it given I'm not a virgin and have a high chance of being exposed to HPV already (in which case it's too late), and am therefore not eligible anyway.
posted by shelleycat at 1:28 AM on June 19 [+] [!]

It's not "too late." Even if you've been exposed to one strain of HPV already, it's unlikely that you've been exposed to all of the strains covered by the vaccine. And obviously many women are not virgins at 26. I'm not saying you should get it if you don't want it, but previous HPV exposure doesn't disqualify you.
posted by Violet Hour at 4:23 AM on June 19, 2007

Agreed. I just got my first Gardasil shot a few months ago after a bad pap smear led to biopsies and cryotherapy, and I'm almost 30.

If I had known earlier that I could possibly have spent $300 and avoided some of this nonsense, I would have spent it in a heartbeat.
posted by zebra3 at 11:07 AM on June 19, 2007