Immunizing Patients Is Worth Pharmacists' and Technicians' Time

Life-saving vaccines have had a profound impact in this country and worldwide. According to the CDC, from 2006 to 2017, almost 3.5 billion doses of vaccines were distributed in the United States.¹ From an economic perspective, every $1 spent on vaccines amounts to $3 in direct benefits, and these benefits can go up to $10 if societal costs are included.² Globally, 2 to 3 million fewer deaths in the world occur each year because people are vaccinated and protected.³

Today, almost anyone can receive immunizations against 17 once common and potentially deadly infectious diseases in the United States.⁴ However, many patients still fall through the cracks because providers fail to ask about topics such as travel plans, school health needs, or if they have received immunizations for high-risk environments. Although we have made great strides, nearly eradicating numerous vaccine-preventable illnesses, we still have some work to do to get our current immunization trends and populations up to date. For example, on one end of the spectrum, the percentage of patients across every age group has improved for influenza coverage in the United States.⁵ Conversely, the need for immunization improvement continues in the area of pneumococcal disease, which is lingering below Healthy People 2020 targets⁶ (also see Healthy People 2020: Immunization Goals).

Pharmacists have been involved with vaccines since the 1800s, but have actively been involved in the routine immunization of patients only for the past 20 years or so. The role of pharmacists in the provision of vaccines has changed and expanded considerably since the first immunization training program in 1994. Since then, pharmacists have progressed from being vaccine advocates to becoming full partners in providing immunizations. Today, many patients may not imagine going anywhere but a pharmacy to get their flu shot.⁷

As the emphasis on preventive care continues to grow, many states are expanding the role of pharmacists as experts in immunizations. According to the most recent update from the American Pharmacists Association in January 2018, pharmacists in all 50 states, as well as the District of Columbia and Puerto Rico, are permitted to administer immunizations.⁸ Depending on the state, pharmacists can administer vaccines pursuant to a prescription or according to a protocol, while in others, no physician oversight is required. In all but 4 states, pharmacists can provide any vaccine to patients, and in about half of states, pharmacists can provide vaccinations to patients of any age. In every state, pharmacists can administer the most commonly sought adult vaccines for influenza, pneumococcal disease, shingles, and tetanus/diphtheria/pertussis. In 2017, Idaho became the first state to allow pharmacy technicians to administer immunizations, although a pharmacist is still required to perform all of the clinical elements of the immunization, such as prescription verification and patient counseling.⁹

Currently, immunization is the #1 patient care service offered by community pharmacists, highlighting the important role pharmacists play in public health. A total of 73% of community pharmacies offer immunization services, according to 2018 NCPA Digest.¹⁰ If one subscribes to the glass-halfempty mentality, only 73% of independent community pharmacies offer immunizations. Clearly, with less restrictive state laws and regulations, that number needs to be, and should be, higher. If your pharmacy is not offering vaccinations as a patient service, consider that you are missing out on an opportunity to help your patients and expand your business.

Look at the recent multistate measles outbreak as an example.¹¹ This resurgence of a disease that had nearly been eradicated may offer the perfect opportunity for pharmacists to start a conversation with patients and employers about the services that are offered which go beyond dispensing. As the most accessible health care providers, community pharmacists have the opportunity, and the obligation, to help patients understand vaccine safety and help dispel the myths created by the small but vocal antivaccine movement.

More than 100 million Americans get a flu shot every year,¹² which produces $4 billion to $5 billion in revenue,¹³ yet the immunization market remains largely untapped. A huge opportunity is waiting to be uncovered beyond the flu shot. Pharmacists should use the flu shot “encounter” to access the patient immunization record, identify gaps in care, and proactively recommend other age-appropriate vaccines. As Beverly Schaefer, RPh, pharmacist and owner of Katterman’s Sand Point Pharmacy in Seattle, Washington, stated, “If you want to add profit to your bottom line, increase the number of immunizations that you’re doing. Every single immunization that you do adds to your bottom line. There are no exceptions.”¹³

Offering immunizations provides opportunities for pharmacies far beyond the revenue that is generated from this service. Pharmacy-based immunization services help build a relationship based on trust between the patient and the pharmacist, leading the patient to rely more on the pharmacist for a wide array of services such as medication synchronization, diabetes education, over-the-counter recommendations, prescription delivery, health screenings, medication therapy management services, and traditional prescription dispensing. Immunizations go a long way toward branding the pharmacy as a destination for health and wellness, an important differentiator in today’s competitive marketplace, which includes a growing number of online and mail-order pharmacies.

Finally, immunizations are a core service set for pharmacies participating in enhanced services networks such as the Community Pharmacy Enhanced Services Network. These pharmacies are required to screen patients for Advisory Committee on Immunization Practices—recommended immunizations, educate patients about needed immunizations, and, if necessary, refer to other health care providers. In today’s health care environment, with the focus on collaborative, team-based care, it is critical that health care providers try to eliminate any remaining and, in some cases, perceived barriers (ie, physician opposition) to providing this important public health service.

Immunizations are among the best ways for pharmacists to demonstrate their value. Pharmacy-based immunization services not only save costs and produce revenue, but also improve patient health and contribute to better outcomes, illustrating the value that pharmacists bring to the entire health care team. Let’s seize the opportunities before us and leverage our position as America’s most accessible health care providers to positively impact public health.

John O. Becker, RPh, is the senior director, strategic initiatives, at the National Community Pharmacists Association in Richmond, Virginia.

REFERENCES

• Vaccine Injury Compensation Data. Health Resources & Services Administration website. hrsa.gov/sites/default/files/hrsa/vaccine-compensation/data/monthly-stats-july-2019.pdf. Updated July 2019. Accessed July 16, 2019.
• Vaccine statistics and numbers. Vaxopedia website. vaxopedia.org/2018/01/10/vaccines-statistics-and-numbers/. Updated February 2, 2019. Accessed July 16, 2019.
• 10 facts on immunization. World Health Organization website. who.int/features/factfiles/immunization/en/. Updated March 2018. Accessed July 16, 2019.
• Table 1. recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2019. CDC website. cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Published February 5, 2019. Accessed July 16, 2019.
• Early-season flu vaccination coverage—United States, November 2018. CDC website. cdc.gov/flu/fluvaxview/nifs-estimates-nov2018.htm. Reviewed December 14, 2018. Accessed July 16, 2019.
• 2020 topics & objectives: immunization and infectious diseases: national snapshots: IID-7.7. children receiving 4+ doses of PCV by age 19-35 months (percent) by race/ethnicity. Office of Disease Prevention and Health Promotion website. healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/national-snapshot. Accessed July 16, 2019.
• Hogue MD, Grabenstein JD, Foster SL, Rothholz MC. Pharmacist involvement with immunizations: a decade of professional advancement [published correction appears in J Am Pharm Assoc (Wash DC). 2006;46(3):308]. J Am Pharm Assoc (2003). 2006;46(2):168-179; quiz 179-182.
• American Pharmacists Association and National Community Pharmacists Association (NCPA). Pharmacist administered vaccines. American Pharmacists Association website. media.pharmacist.com/practice/IZ_Authority_012019.pdf. Updated January 2019. Accessed July 16, 2019.
• Bright D, Adams AJ. Pharmacy technician-administered vaccines in Idaho. Am J Health Syst Pharm. 2017;74(24):2033-2034. doi: 10.2146/ajhp170158.
• NCPA. 2018 NCPA Digest. www.ncpanet.org/home/ncpa-digest. Accessed July 16, 2019.
• Measles (rubeola): measles cases and outbreaks: measles cases in 2019. CDC website. cdc.gov/measles/cases-outbreaks.html. Reviewed July 15, 2019. Accessed July 16, 2019.
• Influenza (flu): historical reference of seasonal influenza vaccine doses distributed. CDC website. cdc.gov/flu/prevent/vaccinesupply.htm. Reviewed August 23, 2018. Accessed July 16, 2019.
• How to make immunizations a pharmacy profit center. PBA Health website. pbahealth.com/how-to-make-immunizations-a-pharmacy-profit-center/. Published March 15, 2019. Accessed July 16, 2019.