June 10, 2015
For El Dorado TrueCare Pharmacy in El Dorado, Kan., planning, prepping, organizing and marketing its flu program is an almost never-ending project—but well worth it.
“Our flu shot season runs from the end of August through January or February,” said Jennifer Clausing, R.Ph., staff pharmacist at El Dorado TrueCare Pharmacy and head of its vaccination program. And once the season ends, it’s time to prepare for the next one.
“In February, I start to get my numbers together to analyze what was used in the past season and to plan what to order for the next year,” she said. “By March, I’ll place my vaccine order.”
Despite the extra work involved, offering flu vaccines is a revenue-generating service for independent community pharmacies. Pharmacies can earn a decent margin on every flu shot they provide, which can number in the hundreds. “Profitability for influenza vaccines are 50 to 100 percent above the cost of the vaccines alone,” said Luke Noll, director of vaccine product sales and corporate accounts at FFF Enterprises, a supplier of critical-care biopharmaceuticals, plasma products and vaccines.
Besides margins, offering flu shots can also get patients in your store. “Running a pharmacy-based influenza vaccine program during flu season can bring increased exposure and traffic into your pharmacy,” Noll said.
Improving the bottom line is always good, Clausing said. “But there’s also that extra touch, that extra time with the patient that’s very valuable. You can talk about diabetic shoes or do another vaccine. Maybe they need a pneumonia shot or the Zostavax® vaccine. There’s a lot of ways you can tie in those extra services.”
El Dorado TrueCare Pharmacy has offered flu shots for the past five years. Ordering well is a big part of making the flu program successful each year.
Clausing said she places her flu vaccine order during the last week of March. Called pre-ordering, many flu vaccine vendors recommend booking before March 31.
“We encourage pharmacies to estimate and book their vaccines as early in the season as possible because supplies of some of the preferred vaccine products can be sold out by late spring,” Noll said. “The choice of delivery dates is also better if you order early.”
Determining how many—and which—vaccines to order can be tricky to calculate, especially if it’s your first time offering flu shots.
If you’re just starting out, keep it simple. “When starting a program, I would recommend starting out slow the first year and determining what you feel is a comfortable level of vaccinations to handle based on your staffing, the population size of your immediate community and your current number of pharmacy customers,” Noll said.
El Dorado TrueCare Pharmacy built its flu shot program gradually. “We didn’t start doing 800 shots our first year,” Clausing said. “We did maybe 100, and we built up to where we are now.”
Pharmacies that have offered flu shots for a year or more can look at their numbers to determine what to order. “Keep track of the total number of doses given in the season and when you see the greatest turnout,” Noll said. “Does the greatest demand occur in September? October? That way you can better plan for the next year.”
Every flu season, Clausing keeps detailed records. For example, she keeps track of how many flu shot patients paid with Medicare, private insurance or cash. “Last year we did 835 flu shots; 500 of those were billed to Medicare, 150 were cash, 164 were commercial plans and 21 were to employees.” This year, she predicts the number of commercial patients will increase because more commercial plans are paying for flu shots.
She also looks at the price of the vaccines before ordering.
“It’s a balancing act,” she said. “When I’m analyzing, I look at what Medicare paid last year on each vaccine. There are three or four different vaccines from different manufacturers, and depending on what Medicare is reimbursing and what I can buy for, I analyze which one I’m going to order in.”
Increasingly, patients are turning to pharmacies instead of doctors’ offices to get their flu shots. “About 20 percent of influenza vaccinations are given today in the retail pharmacy setting and growth is expected to continue,” Noll said.
“Pharmacies offer the convenience of extended hours, close proximity to where patients live, and pharmacists are becoming more valued as partners on patients’ health care teams,” he said.
When El Dorado TrueCare Pharmacy first got into the vaccine arena, the staff wasn’t sure how local doctors would react.
“One of our concerns was that we would be stepping on local doctors’ toes,” Clausing said. But they found that their local physicians were happy to send patients their way.
“We find that each year, more and more doctors aren’t wanting to do shots in their offices, and we’ve seen more patients coming to our pharmacy,” she said.
El Dorado TrueCare Pharmacy also offers flu shot clinics to employers, assisted living facilities, senior centers and senior residences. “You can do 50, 60, 70 shots in two hours and it’s really easy,” Clausing said. The clinics increase volume and help reach patients who may not normally come into the pharmacy.
Between the extra business from doctor referrals and the flu shot clinics, Clausing has even needed to order more vaccines mid-season.
If that happens, it isn’t usually a problem for pharmacies to secure more vaccines. “Reorders of vaccines during influenza season are common,” Noll said. “We usually purchase additional vaccines from our manufacturing partners and have them in stock and immediately available for next day deliveries.”
At the end of the season, you can even return leftover vaccines for credit. “All injectable vaccines sold during the influenza season have a return allowance, and this usually ranges from 20 to 30 percent of the total influenza vaccine ordered,” Noll said. “It’s common for leftover vaccines to be eligible for up to 100 percent return credit.”
One of the biggest challenges of starting a flu shot program is finding the time to do it.
How do you give 800 shots in a flu season on top of your normal work? El Dorado TrueCare Pharmacy solves this problem by incorporating vaccines into its regular workflow, and the staff handles them like normal prescriptions.
“When patients come in for a flu shot, we have them fill out the screening form and the technician starts processing the claim, just like a regular prescription,” Clausing said. “When it’s given to the pharmacist for verification, the pharmacist gathers the supplies and gives the shot.”
“It does get busy, but I think we all enjoy the extra business,” she said. The pharmacy has three vaccinating pharmacists and typically also gets a student to help administer vaccines during flu season.
Even though pharmacies face obstacles when implementing a flu program, they can use that knowledge to improve the next year.
“Make observations during the season and make notes of what worked well and what needs to be refined,” Noll said. “Did you have enough staff? Were patients waiting too long? Was the process smooth? Did you have the billing in place? And, what can be changed to make the program better?”
Clausing said it’s also important to talk to all of your staff members. “We discuss how the season went and what goals we want to put in place for next year,” she said. “Maybe we want to add another flu clinic or see how a trend is going to change.”
For the upcoming flu season, Clausing is planning to put together vaccination kits to streamline the process. “We’ll put together kits in plastic bags that include everything needed to give the vaccination: the syringe, gloves, alcohol swabs and bandages,” she said. “When you go to give the vaccination, you can just grab one of those kits to make it real quick and easy.”
When it comes to running a compliant flu vaccine program, you need to stay up-to-date with constantly changing policies and procedures. These include state regulations, federal regulations, state board of pharmacy requirements and more.
“The legal requirements vary from state-to-state regarding which vaccine a pharmacist is able to administer, the age limits on the patients you can administer to, or other restrictions as defined by state boards of pharmacy. Pharmacists must check with their specific state board of pharmacy before initiating any immunization service to determine their specific authority to immunize,” said Scott Weaver, R.Ph., vice president of pharmacy at PRS Pharmacy Services.
PRS Pharmacy Services recommends paying attention to protocols, as this is an area pharmacists tend to forget. State governments often require pharmacists to document and to provide information to the state when a vaccine is administered. Make sure you pay attention to patient PCP notification, state-required protocols and state and local registries.
If an adverse reaction or vaccination error occurs, you may also need to report the vaccine administration to the Vaccine Adverse Event Reporting System (VAERS).
In the event of an error or oversight, you’ll want to make sure that your general malpractice liability policy covers vaccinations ahead of time. “The wording you want is ‘medication administration’ or ‘errors and omissions,’” said Joshua Potter, director of compliance at PRS Pharmacy Services.
Pharmacies with an immunization program also need to have an infection control program in place to educate staff and to help reduce the potential for exposure to blood-borne pathogens.
And, don’t forget to hand out the required vaccination information sheets to patients or guardians. “Those are updated a couple of times a year, so you need to make sure you’re providing the correct version,” Potter said.
If you don’t want to handle all of the documentation yourself, programs are available to make the process easier. IMMUTrack from PRS Pharmacy Services is an online program that helps pharmacies set up all of the policies and procedures needed to offer a safe, efficient and effective immunization program.
“In order to run a good immunization program, pharmacists must make a commitment to stay up-to-date with policies and procedures, and that’s where our program comes in,” Weaver said. “We’re providing the up-to-date policies, the new regulations and protocols that occur and much more. With our program, they don’t have to go out and search the Internet and take that extra time and effort. It’s all provided for them.”
It takes time to develop a flu program that runs smoothly. But when you do, making the most of flu season can help your patients and your business.
“There’s usually a multiplier effect,” Noll said. “Vaccinations drive traffic into the store, where patients will purchase other items on that same visit.”
When you get new patients in the door to get a flu shot, you have an opportunity to build a relationship with them. Clausing said they have a name for the phenomenon at El Dorado TrueCare Pharmacy. “We call it a touch,” she said. “They get that touch, that one-on-one time with a pharmacist. And that touch turns into new customers down the line. It’s invaluable and you can’t market for that.”
For Clausing, the best part of offering vaccines comes down to that extra time with the patient. “Having that time with them is personally fulfilling,” she said. “It’s why I became a pharmacist.”
Expect more patients to request the Fluzone® High-Dose vaccine.
Don’t be surprised if many of your patients are asking for the Fluzone® High-Dose vaccine this season. The Fluzone High-Dose vaccine, which is specifically for patients 65 years of age and older, is increasing in popularity, according to Luke Noll, director of vaccine product sales and corporate accounts at FFF Enterprises. The vaccine has four times the antigen of a regular flu shot and can provide a stronger immune response in older adults.
Pharmacies are seeing patient interest in the vaccine, too. “Last year was the first year I ordered the Fluzone High-Dose vaccine and I used it up really quickly,” said Jennifer Clausing, R.Ph., staff pharmacist at El Dorado TrueCare Pharmacy in El Dorado, Kan. “I took it to an assisted living facility and I had a lot of requests for it in the store, so this year I’m going to order more.”
The do’s and don’ts of properly storing flu vaccines.
Do use thermometers that monitor and track temperatures. They’re not required by law, but are highly recommended.
Do choose a refrigerator of sufficient size to ensure stable temperature.
Do check and document the refrigerator’s temperature at least twice daily, at the beginning and end of the workday.
Do have a plan in place to address temperature anomalies and loss of power.
Do store influenza vaccines under refrigerated conditions at a temperature of 2 to 8 degrees C (35 to 46 degrees F).
Don’t over pack the refrigerator.
Don’t place vaccines in the door or bins. Air needs to circulate evenly.
Don’t store vaccines with other products, food or drinks.
Don’t store expired or unusable vaccines with usable vaccines.
Sources: FFF Enterprises; PRS Pharmacy Services