Vaccination by pharmacists: Arizona's list of permissible vaccines and immunizations may soon expand

March 1, 2009

Arizona proposal would expand list of vaccines given by pharmacists

Key Points

After some controversy, pharmacists and family physicians in Arizona have agreed on a state bill that would allow pharmacists to give certain vaccines without a prescription.

In early February, the Arizona Pharmacy Alliance, the Arizona Academy of Family Physicians, and other groups agreed on an amendment to state H.B. 1624.

The bill, passed in the House Health Committee in 2008, would expand the list of immunizations and vaccinations, including new vaccines for tetanus and shingles, that pharmacists can give to their customers without a prescription. In Arizona and several other states, patients must have prescriptions from physicians before pharmacists can administer vaccines and immunizations on the list of recommended vaccines for adults issued by the Centers for Disease Control and Prevention (CDC).

Family physicians in Arizona, though, are worried about pharmacists giving the shots. "There is not a consensus among our members. Some think they should be given in a medical home," said Laura Hahn, executive director of the Arizona Academy of Family Physicians.

The physicians are frustrated by the increase in vaccinations pharmacists are allowed to give because physicians administer vaccines and immunizations, and "would be happy to do that in their offices," Hahn said. In addition, certain vaccines may result in adverse reactions, and patients should be counseled about these and other consequences before they receive vaccines and immunizations. For example, physicians explain to patients that the HPV (human papillomavirus) vaccine does not protect them from contracting STDs.

Still, pharmacists' use of vaccines can complement the work of family physicians, Rasmussen said. "Physicians would see increased referrals to their offices, [where] they will have more intimate conversations with their patients," she said.

Despite some controversy over the proposed legislation, the family physicians, the Arizona Pharmacy Alliance, and other stakeholders such as the Arizona Medical Association and the Arizona Nurses Association, agreed to wording of a new bill.

The new amendment, which will probably be introduced in the Arizona House this spring, requires the Arizona Department of Health to keep a list of vaccines that may not be administered without a prescription. The Arizona State Board of Pharmacy will select an advisory committee, made up of physicians, nurses, and other healthcare professionals, who will decide which immunizations are deemed "too dangerous" to be administered by a pharmacist.

In addition, the administering pharmacists must first be certified by the Board of Pharmacy to give vaccines and immunizations. That certification also allows pharmacists to administer emergency medication to manage acute allergic reactions to those shots.

Also, the pharmacist is required to report the vaccination to the patient's physician - even when a prescription was not required - within 24 to 48 hours after the shot was administered.

New wording included in the bill, which would make the patient's primary-care physician "immune from liability for any adverse reaction, complications or negative outcome," was lauded by the Arizona Academy of Family Physicians. "We are immune from lawsuits ... from anything having to do with immunizations without a prescription," Hahn said.

The revamped bill is likely to be introduced as a new bill in the state House of Representatives, then in the Senate. The Arizona Pharmacy Alliance and the Arizona Academy of Family Physicians are optimistic that it will be passed this year. "It is a crazy year here. The only concern is that [the state legislature isn't] holding hearings until the budget is finalized," Hahn said.

Christine Blank is a writer based in Orlando, Fla.