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State rules that limit pharmacists from administering adult vaccines are a barrier to raising immunization rates.
Patients would save both time and money if neighborhood pharmacies could administer more adult vaccines. However, state-level regulations remain a significant barrier to achieving this goal.
According to the study released by the Pacific Research Institute, reforming federal laws to allow pharmacists to administer all the vaccinations recommended by the CDC would be a significant benefit to public health.
"It's the policy that becomes the barrier and the policy is basically at the state level," economist Wayne Winegarden, PhD, the study's author and a senior fellow for the Pacific Research Institute, tells Drug Topics.
He said inconsistency across state regulations and policies in regard to vaccinations present significant challenges for large national chains that must sort through and comply with multiple standards and policies. Smaller, independent pharmacies can also face challenges, particularly in states that require more complex protocols or a doctor's prescription prior to receiving a vaccine.
"It's the red tape, especially at the community pharmacies where you don't have the infrastructure or the personnel to be messing around with excessive regulations," he says. "That's where it could be most impactful."
Despite the barriers, Winegarden says significant research has shown the advantages of having a pharmacist provide more adult immunizations.
For instance, previous research done by Drozd et al. that found states had significantly higher influenza immunization rates after policies were changed to allow pharmacists to administer the vaccines, he notes in his study.
Winegarden also argues that neighborhood pharmacies are more accessible for adults and would allow vaccinations to occur in the evenings, over lunch hour, or on weekends.
"There's a huge convenience benefit," he said.
Providing immunizations at pharmacies not only saves patients time, but also saves money. The discrepancy in pricing between medical settings was documented in a 2014 study led by Singhal and Zhang, which found the price for the shingles vaccine was $208.72 on average in a physician office compared to an average price of $168.50 at a pharmacy.
Many pharmacies already offer influenza vaccines, but Winegarden believes if there were national standards and reporting requirements to guide pharmacist's involvement, pharmacies could offer more immunizations.
Despite CDC recommendations, adult vaccination rates remain low. According to data from the 2016 National Health Interview Survey, just 33.4%of adults age 60 or older had received the herpes zoster vaccine while 66.9% of adults age 65 or older had received the pneumococcal vaccine. An even smaller percentage, or 26.6%, of adults age 19 or older had received the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) vaccine.
Winegarden believes pharmacists can help to boost these figures by offering the immunizations at lower costs in more convenient settings.
"Based on the results that have come into date, you do see a meaningful change in the vaccination rates when you increase the convenience," he said.