Independent Pharmacies Are Well-positioned to Vaccinate Their Communities Against COVID-19

Pharmacy Times^® interviewed Thomas D’Angelo, RPh, president of the Pharmacists Society of the State of New York, on how independent pharmacies may be well-positioned to assist CVS and Walgreens pharmacies in the administration of coronavirus disease 2019 (COVID-19) vaccines throughout the country.

Alana Hippensteele: So, Thomas, why are independent pharmacies important to consider as a resource for COVID-19 vaccinations in the country, and specifically in the state of New York, where you’re based?

Thomas D’Angelo: So, in the state of New York, there are over 2000 independent pharmacies, and they are all well positioned in their communities, they are there for years, they speak the language of those communities, if it's a different language other than English. You know, we have Spanish-speaking, Italian-speaking, German-speaking [pharmacists] everywhere in the state.

These pharmacies get along very well with their community members, with the patients that walk into their stores. Those patients trust those pharmacists, they trust the pharmacies, they've been using them for generations. So that's why they will be more likely to accept a vaccine from somebody that they trust, that they know—not to mention the fact that, with so many of us, so many independent pharmacies, that's a lot of vaccination centers. Even if they're just doing a few hundred a week, that's still a lot of vaccines that can be administered in the community itself.

Alana Hippensteele: Yeah, absolutely. Why is the role of independent pharmacies in the administration of COVID-19 vaccines an important issue to your organization, the Pharmacists Society of the State of New York?

Thomas D’Angelo: So, pharmacists in New York have been fighting to do all CDC-recommended vaccines for years. Right now, we are not allowed to do all CDC-recommended vaccines, we're only allowed to do a certain number: shingles vaccine, flu vaccines—along the lines of those vaccines. When we started lobbying to have all CDC-recommended vaccines probably 7 years ago, we knew that the potential was there to really help in the community, to make sure that we could do the vaccines.

Then when COVID came along, it became an emergency, and it had to be executed with executive orders, and we had to jump through hoops to get certain things in place so that we could get moving on this. We have to have executive orders for the standing orders for the vaccines, we had to have executive orders for billing of the product—there were a lot of hurdles, and it slowed down the process.

We were asked several years ago during the flu epidemic, when it was very bad, to start vaccinating children, which we were not allowed to do for children under the age of 18. But during that epidemic, they realized the value of pharmacies being able to vaccinate quickly and really get the population covered, and we were playing on that, saying, ‘Look we helped you with the flu, you need to get all CDC-recommended vaccinations because if we don't have that, things like this happen,’ and that's exactly what happened with COVID.

Alana Hippensteele: Yeah. What may be the reasons the government is primarily relying on CVS and Walgreens pharmacies for COVID-19 vaccinations at this time, and do you see any signs that the government may be considering independent pharmacies as a resource for COVID-19 vaccine administration as well in the future?

Thomas D’Angelo: Yeah, so I'm really not sure why CVS and Walgreens were given that contract. I think CVS sold a bag of goods to the government and really told them, ‘We can handle this, we have manpower, we have the ability to do this,’ and the evidence up to now has been no, they have not had that ability, and they did not have the staff in place. When they got that contract, they started scrambling to hire people, and put more techs in place. Some of the states had to increase their tech ratios to offset the loss of pharmacists and stores. So, I think that might have been a mistake.

Walgreens, from what I hear, is doing a good job, or a better job, but again, you're talking about 2 companies where they're profit-motivated, and when profit is your motivation, and you have one pharmacist working with 6 techs or 4 techs, and where are you going to get the staff to go out and vaccinate entire residences, entire adult facilities? I never understood that.

But community pharmacy certainly, I mean a lot of long-term care pharmacies, the small community long-term care pharmacies, they can set up contracts with those facilities and get somebody in there to do that vaccinating as well. Plus most long-term care facilities have nursing on staff, so we could have just sent the vaccines to those facilities and had them vaccinate their residences.

Alana Hippensteele: Right, right. What are some of the potential barriers to having independent pharmacies participate in the current national COVID-19 vaccination rollout, and do you see any ways to overcome any of these issues?

Thomas D’Angelo: The barriers are slowly lifting. We have barriers with billing, obviously. Many pharmacies can't bill medically. So especially for Medicare, it has to be billed under part b, they have to bill on the pharmacy side. A lot of that is lifting now, and there are some pathways that we can approach to get those things done. But the billing is the biggest issue for us because, obviously, getting the vaccines and getting the vaccines administered is not our issue, it's whether we get the vaccines on time, how many we get, and how quickly we can administer them.

But billing is our issue. We have to have the codes, we have to have the pathway there so that we can move quickly and smoothly and be reimbursed for what we do. We're hiring staff as well. My own pharmacy is taking on several employees right now just to make sure this goes smoothly.

Alana Hippensteele: Yeah. In your view, are there any changes that could be made to support the country in the process of quickly and effectively rolling out the COVID-19 vaccination process this year?

Thomas D’Angelo: The only the only changes I could see is pharmacists have to be involved, and I think if the government—the federal and state-level government—gets involved and says, ‘We want the pharmacist to have a real easy pathway here.’ We want to open up and make the insurance companies play along with us. Don't fight back, don't let the PBMs get in the way because PBMs tend to get in the way of what we're trying to do. They cut our reimbursements, they block and make prior authorizations involved, they deny claims—if all of those roadblocks are taken out of the picture, it would really improve the way we can operate.

Now, we're not saying that we're going to be able to make the vaccine and administer it—we have to take the vaccine from who's manufacturing it. But our job will be that much easier if we can concentrate on administering the product rather than fighting to get paid to do it

Alana Hippensteele: Right. Do you have any closing thoughts?

Thomas D’Angelo: The only closing thought I have is I would like the public to slow down, relax. This is a big undertaking. We've been, from my own personal experience, inundated with phone calls. My phone system is getting slammed. We had a hundred thousand phone calls by 10 am on Friday morning. There's no way our phone system could have handled that. The public has to kind of relax.

I understand there's a lot of nervous people out there, but let the process take effect. Get the elderly vaccinated, the ones who are most susceptible, get the people who are fighting on the frontlines—the nurses, the doctors, the police, the firemen—all of these guys that are getting exposed every day, let them get their vaccines, and let's do this in an organized fashion.

I think within several months we can have this done, it's just a matter of everyone slowing down and realizing that they will get their shot. I know there's a lot of apprehension, a lot of tension, but that kind of creates more of a problem, and it doesn't let the process unfold.