When it comes to state vaccination laws, pharmacists are gaining increasing authority to administer immunizations, but association experts say there’s still work that needs to be done.
“Pharmacy differs from other health professions like medicine in that our authority is state dependent,” Mitchel C. Rothholz, RPh, MBA, Chief Strategy Officer for the American Pharmacists Association, said. “Our vision for pharmacists’ authority is that pharmacists will be authorized to administer all (Advisory Committee on Immunization Practices) recommended vaccines as valued members of the immunization neighborhood.”
Although pharmacists in all 50 states have been given the authority to administer influenza vaccines to adult patients, pharmacists in some states are still limited by which vaccines outside of influenza they are able to administer, the age of patients they are able to administer to, and whether a patient needs a prescription before getting a vaccine at the pharmacy.
According to a January 2019 report released by the National Alliance of State Pharmacy Associations, pharmacists in 48 states—including Puerto Rico and the District of Columbia—are authorized to administer all vaccines to adult patients. However, 9 of those states require prescriptions for at least some of the vaccinations.1
Four states still do not have the authority to administer all vaccines, the report found.1
Many states also continue to limit pharmacists’ vaccination authority by age restrictions for the patients they are able to immunize, with just 27 states allowing pharmacists to administer to any age—for at least for some of the vaccinations, according to the report.
“With respect to pharmacists’ authority to be able to administer vaccines, there’s just a patchwork of laws across the country,” Michelle Cope, director of federal and state public policy for the National Association of Chain Drug Stores (NACDS), said.
Some states have made recent progress to expand pharmacists’ authority. In Wisconsin, a bill was recently passed that expands a pharmacists’ ability to administer vaccines for any age, as long as a prescription is obtained for certain vaccines. It also gives authority for pharmacy students to administer vaccines if they are under the direct supervision of a pharmacist.2
Legislators in South Carolina are also expected to consider a bill in the upcoming legislative session that would lower the age for pharmacist-administered vaccines. What makes this bill unique, according to Allie Jo Shipman, PharmD, MBA, director of state policy for the National Alliance of State Pharmacy Associations, is that it was brought up by parents who wanted to see the changes made.
“You are seeing now that it’s not just pharmacists, but the public, I feel like the patients are really starting to see the pharmacy as the place that they go for that public health care,” Shipman said.
Goals Of Pharmacy Associations
Although there has been advances at the state level, pharmacy association leaders say there is still progress to be made. “Our broadest policy goal is for pharmacists to have autonomous authority to provide immunizations for all FDA-approved vaccines that are available and that have been approved by the FDA in the same manner as all other vaccine providers,” Mary Ellen Kleiman, senior vice president of state government affairs/deputy general counsel for NACDS said.
Cope said NACDS is now looking to “standardize” the vaccine types that can be administered while also eliminating the administrative barriers that still exist in some states that make delivery more challenging.
John Beckner, RPh, senior director of strategic initiatives for the National Community Pharmacists Association (NCPA) echoed those sentiments, saying the NCPA believes pharmacists should be able to administer any approved vaccine to any patient.
“I think NCPA as an association really believes that immunization services really need to be a core competency of the pharmacy profession,” he said. “It’s such an important service that we offer and we began offering it in the mid-to-late ‘90s, so obviously something that we feel is very important.”
In addition to expanding authority for pharmacists, Beckner believes that it’s also important to give pharmacy students the authority to administer vaccines under the supervision of a trained pharmacist as part of their training.
“Certainly, it makes sense that these students and interns need to be trained to provide immunizations if it is going to become a core competency and service offered by all pharmacies,” he said.
Tackling the Under-17 Market
One of the largest challenges remains expanding pharmacists’ authority to administer vaccines to those patients 17 years of age and younger.
Pediatricians and legislators have historically been more cautious in allowing these vaccines to take place outside the physicians’ office, but Cope said she believes pharmacists’ success in adult immunizations has helped to quell possible concerns.
“It’s just getting policy makers to get comfortable with the idea, but the evidence now has grown that pharmacists are great providers for vaccines, that they are convenient to access, that they can help improve overall vaccine rates, so I think with that growing evidence that’s really kind of put policy makers minds at ease around this,” she said.
Although the rate of adolescents who are receiving the recommended vaccines continues to rise, the population group continues to lag behind younger children, according the US Department of Health and Human Services.3
Cope believes if pharmacists in more states are given the authority to administer vaccines to adolescents, they could help close this gap and improve adolescent vaccination rates.
“If we’re opening pharmacists’ vaccines up to that age group in particular, given that pharmacists have historically improved vaccine rates, I think that that can really help to address that,”she said.
What Pharmacists Can Do To Help
Pharmacists can help expand pharmacists’ authority on an individual level by continuing to demonstrate their capabilities and value as an immunization provider.
“When others outside our profession advocate for our increased inclusion then we are doing things right—and there are folks doing this,” Rothholz said.
Shipman said pharmacists also need to make sure “they are doing everything in their practice to provide the vaccines that people need,” whether that’s expanding the current offerings, keeping vaccines fully stocked, or taking a proactive approach to determining which vaccines a patient may need.
Although the industry has “made incredible progress,” Shipman said there is still “a long way to go.”
Advances can still be made both within state legislatures and in individual pharmacies themselves as they continue to offer more vaccine options for patients.
“I think that’s the area where we as an association are encouraging our members to expand is their vaccine portfolio because it’s such an opportunity for them to diversify their revenue, but it’s also an opportunity for them to have an impact on the public health arena,” Beckner said.
Pharmacists can also support the efforts of their state pharmacy associations by inviting state legislators into their practices to show the value of the services they provide or take a more active role in advocacy efforts at the state level themselves.
“Certainly, pharmacists on the state and local level can become actively involved with their legislature, they can continue to forge relationships in the medical community and really market and advertise their services to let people know that they are an immunizer and what vaccines they are able to offer,” Beckner said. “The more people that know about it, the more likely that it’s going to be an accepted practice.”
- APhA/NASPA. Pharmacist Administered Vaccines [report]. NASPA’s website. Published January 2019. https://naspa.us/wp-content/uploads/2019/04/IZ-Authority-012019.pdf.
- State of Wisconsin 2019-2020 Legislature. 2019 Assembly Bill 137. http://docs.legis.wisconsin.gov/2019/related/proposals/ab137.pdf.
- Department of Health and Human Services. Vaccines and Adolescent Development. HHS’ website. https://www.hhs.gov/ash/oah/adolescent-development/physical-health-and-nutrition/vaccines/index.html.