Worth a Shot: How Vaccine Policy Impacts Independent Pharmacies

Independent pharmacist Tom DePietro, PharmD, is on the front lines of the vaccine landscape and how it is being reshaped by policy at the pharmacy counter. He stated that he is seeing how national debates over immunization schedules translate into everyday uncertainty for patients.

“I think the biggest thing that has changed is just a little bit tougher conversations with customers in the store [and] confusion from customers whether they're eligible to get a vaccine or not eligible to get a vaccine,” he said.

Since changes to ACIP and ongoing legal challenges around federal vaccine recommendations, DePietro said the most visible impact hasn’t been new rules or major operational overhauls but the tone and complexity of conversations with patients. He described “tougher conversations” and heightened confusion over something as basic as whether a person is even eligible for a vaccine.

Patients arrive at the pharmacy either wanting a vaccine or acting on the advice of their physician, but the brevity of medical visits means many of their questions are deferred to pharmacists. As a result, DePietro and his team frequently find themselves filling in the gaps left by an overburdened healthcare system.

In Pennsylvania, however, state-level action has helped maintain some stability. When federal recommendations became contentious, the state moved quickly to expand what pharmacists could rely on, adding multiple professional organizations and the FDA as acceptable sources of guidance. DePietro credited PA Governor Josh Shapiro’s proactive steps and the cooperation of the State Board of Pharmacy with allowing pharmacies like his to continue vaccinating largely “business as usual,” even as other states face murkier boundaries.

On the legal front, with federal guidance under court scrutiny and questions about the validity of prior votes, DePietro was less concerned with theoretical liability than with clinical reality. He framed his practice around doing what is best for the patient in front of him: thoroughly discussing benefits and risks, providing real-world context about outcomes, and then empowering patients to decide. If they accept the vaccine, he sees it as a success; if they decline after being fully informed, he views that as a valid outcome as well, because the process respected their autonomy.

The pharmacy has made some modest adjustments to documentation. When certain vaccines required patients to be high-risk or meet specific criteria, DePietro’s team added simple checkbox-style notations so there was a clear record that patients self-identified as high risk. This, he noted, helps if insurers later question why a vaccine was administered, without forcing patients to disclose sensitive conditions in detail. Beyond that, he described operations as relatively unchanged, with the real strain coming from media noise and patient confusion rather than paperwork.

What has changed more noticeably is how proactive vaccine recommendations are received. Previously, DePietro’s team might mention a pneumonia shot to an older adult on an inhaler, and the patient would either accept or decline without much tension. Now, he said, a meaningful share of patients react defensively, assuming the pharmacy is “pushing” vaccines because of what they’ve heard in the news. That shift has made proactive outreach more delicate, even as pharmacists continue to see it as part of good preventive care.

With fall respiratory season approaching and no fresh ACIP recommendations for flu on the books, DePietro was pressing ahead with familiar strategies: walk-in flu shots, newly added appointments to meet patient preference, and outreach clinics in senior housing, community centers, and workplaces. His team sees the season as hectic but deeply rewarding, a concentrated period when they not only protect high-risk patients but also encounter relatively healthy people they see only once a year.

Looking upstream, DePietro believed policymakers are focusing on the wrong problem. Although vaccine schedules have drawn enormous attention, he argued that payment reform is the more urgent and impactful issue for pharmacies and the broader health care system. With emergency rooms backed up, appointments hard to secure, and pharmacies consolidating or closing, he saw a system strained at multiple points. Rethinking how care is paid for would do more to stabilize access and outcomes than the high-profile fights over immunization guidance that currently dominate the headlines.

“There's a lot wrong with our healthcare system today… I just feel like payment reform is probably number one for pharmacies,” he said. “I don't think it's in the vaccine scope. I think it's somewhere else.”