The role of pharmacists is continually advancing, and vaccine administration and education play an important role in the profession. With pharmacists being one of the most accessible health care professionals, patients can receive vaccines more conveniently through expanded hours and flexible scheduling. Pharmacists can administer vaccines in all 50 states, Washington, D.C., and Puerto Rico.1 However, state laws vary regarding whether pharmacists can administer vaccines to children.
Evidence demonstrates that pharmacists improve immunization rates and that the average vaccination cost in pharmacies is usually less than the average cost in physicians’ of ces and other medical settings.2 Therefore, independent pharmacies can help improve vaccination rates and empower patients. Pharmacists can screen, assess and administer many of the vaccines recommended by the Advisory Committee on Immunization Practices.2 Despite these factors, many independent pharmacies do not always provide expanded immunization services similar to those of their chain competitors.1 Independent pharmacies are ideally positioned to offer these services because of relationships they have developed with patients.
Potential barriers may cause some independent pharmacies to be hesitant about expanding vaccine services. One study identified perceived barriers in urban independent and small-chain community pharmacies,3 including 93 independent and 12 small-chain pharmacies in Michigan that participated in the analysis.3 The study found that only seven (6.7 percent) pharmacies administered vaccinations. The most common barriers preventing these services were cited as physician offices administering vaccines, lack of time, lack of interest of pharmacy staff, lack of space and lack of interest in vaccines among patients.
Pharmacists identified the following factors that would motivate them to administer immunizations: increased patient demand, adequate time, appropriate space, adequate staff, change in pharmacists’ attitudes and increased awareness among patients of the importance of vaccines. The study concluded that a majority of pharmacies (65.3 percent) would need only one of these factors to change to inspire them to administer vaccines.3
The shingles vaccine shortage of Shingrix is on everyone’s mind, which prompted the Centers for Disease Control and Prevention to provide guidance for vaccine providers on the back order issue.4 With the high level of demand for Shingrix, there are still ordering limits and shipping delays, which will most likely continue through 2019. If more than six months have passed since a patient’s first dose, the second dose should be administered as soon as possible. The vaccine series does not need to be restarted. Patients who need a second dose should be given highest priority. Pharmacies can also use the Vaccine Finder at vaccine finder.org to locate other providers that may have Shingrix. Pharmacies should also implement a vaccine reminder system using phone, email or text messages to contact patients when Shingrix is available.4
Total PharmacyTM interviewed two independent pharmacy owners who are successfully administering a variety of vaccines to gain their perspectives and advice for other pharmacists interested in expanding their services beyond the flu vaccine. Beverly Schaefer, RPh, is a co-owner of Katterman’s Sand Point Pharmacy in Seattle, Washington. Their mission is to help patients make good health decisions, and they offer all adult immunizations as well as travel vaccines for adults and children. These vaccines include in influenza, shingles, hepatitis A, tetanus/diphtheria/acellular pertussis, pneumococcal and typhoid. The pharmacy also offers consults to discuss travel plans, review immunization history and provide recommendations for any necessary medications to help travelers stay healthy.
Schaefer said that travel and adult immunizations provide a bulk of their business year-round, and a high number of u vaccines are administered in the fall. Schaefer’s pharmacy provides immunization for all ages from infants six months and older; however, they do not routinely administer immunizations for children. Schaefer said they offer all vaccines on a walk-in basis, review the patient’s immunization history to see whether vaccination is appropriate and report it to the primary care physician and the immunization registry after administration.
“Administering vaccines is definitely a profit center for us,” Schaefer said. “In 2018, we administered more than 12,000 doses. That works out to 1,000 per month, 30 per day year-round. Most vaccines can be billed with a $15 to $20 administration fee and take about the same amount of time as lling a new prescription. We don’t usually make $20 on most third-party prescriptions we fill.”
After aggressively marketing the Shingrix vaccine during the first half of 2018, Katterman’s now has a waiting list for the vaccination. Reminders are mailed out once the vaccine becomes available for the first or second dose. Schaefer offered the following advice for independent pharmacies interested in expanding their immunization business: “Set a goal of increasing it by at least 10 percent this year, and put a sign on the front door of your pharmacy that lists all the vaccines you administer.”
Customers will soon realize the benefit and convenience of being able to receive so many vaccines at the pharmacy. Schaefer also recommended developing a checklist of vaccines that have been administered and faxing it to physicians as a reminder that they can send patients to your pharmacy for immunizations.
With so much disruption in the pharmacy space, Schaefer advises independent pharmacies to capitalize on unique offerings that can separate themselves from the pack.
“With Amazon entering the pharmacy marketplace, competition from online retailers, mail order and declining reimbursements, why not offer a service that is immune to all those issues? Offering year-round immunizations is both personally and professionally satisfying as well as a welcome addition to your bottom line,” Schaefer said.
Melody Ann Savley, RPh, and her husband are the owners of Alps Pharmacy in Springfield, Missouri, which offers several immunizations, including influenza, shingles, pneumococcal, tetanus, hepatitis A and B and meningitis. Savley said they increased their flu vaccinations by providing clinics at workplaces and offering immunizations to about 300 employees. Alps uses a questionnaire and their state registry to determine which immunizations patients need. Additionally, the pharmacy consults the H-A-L-O chart from the Immunization Action Coalition to help make decisions regarding appropriate vaccines for patients.5 The factors include health, age, lifestyle and occupation.5
The pharmacists at Alps regularly ask their patients about vaccines as part of their clinical work while completing medication therapy management and when doing sync calls.
“We believe in getting the word out to your physicians and community about the vaccinations you stock,” Savley said. “We find a lot of physicians send business our way because they know we stock the immunizations and feel comfortable administering them. I would call on your local businesses and schools to let them know what you can do for them. Market your pharmacy!”
The bottom line is that independent pharmacies can not only help increase vaccination rates but also boost revenue opportunities. The key is to start slow and gradually increase services. Marketing is also imperative, and developing relationships with local physicians can help to expand immunization services.