October 11, 2013
Before Walgreens started its Take Care Clinic and CVS had its MinuteClinic, D&H Drugstore in Columbia, Missouri was offering vaccines and immunizations to patients. The pharmacy, which has two locations, hired a registered nurse to administer vaccines by appointment more than 10 years ago. The new service offering did so well that the pharmacy hired a second nurse to work full time about five years later.
Vaccines and immunizations have been a good profit center for D&H Drugstore. “When Zostavax® came out about seven or eight years ago, that was big for us,” said Gene Forrester, R.Ph., owner and pharmacist at D&H Drugstore. “That was way before pharmacists could administer vaccines. So, we became one of the first pharmacies in town to do that,” he said.
Now, the vaccine landscape is evolving for community pharmacists.
Since 2009, all 50 states have allowed pharmacists to administer vaccines and immunizations in some form. Depending on the laws in the state, pharmacists may be restricted to only flu vaccines, or they may be able to administer other vaccines, such as Gardasil®, Zostavax, pneumococcal and other vaccinations for travel. The patient age range for vaccines administered by pharmacists also varies by state. Some states don’t allow pharmacists to administer vaccines to children younger than 10 years old, for example.
Missouri passed legislation that allowed pharmacists to dispense vaccines and immunizations in 2007. “When they first allowed pharmacists to do it, my thought was, ‘Well, we have nurses to do vaccines,’” Forrester said. “Then, Walgreens started offering it and you started seeing CVS and the other players out there doing it. That’s when I decided that we needed to look into our pharmacists administering them.”
The legalization of pharmacists to dispense vaccines and immunizations created an opportunity for D&H Drugstore to expand its already well-received immunization services. At the same time, it also created a problem. The pharmacies were currently offering vaccines by appointment or through flu shot clinics, but as patients became more open to receiving immunizations at pharmacies, they were starting to want them on demand.
D&H Drugstore only had one full-time nurse and one part-time nurse to handle vaccinations at both locations. The nurses were often unavailable during certain times considering that the stores were both open 80 hours a week. “I’ve especially noticed in the last year people coming in and asking for either a Zostavax shot or a flu shot, and we didn’t have anybody able to do it,” Forrester said.
To better serve patients, D&H Drugstore is currently working to certify its pharmacists to administer immunizations. That way when patients come in, they can receive the vaccines and immunizations they need with no appointment necessary.
As more pharmacists become certified to administer vaccines, community pharmacists have opportunities to specialize their vaccination services to gain more business.
Hometown Pharmacies, a regional chain of 25 pharmacies located throughout Wisconsin, offers something unique when it comes to pharmacy vaccinations. The Hometown Pharmacy location in Oregon, Wisconsin is home to Safe Travels, a travel vaccination program that gives patients pre-travel consultations, as well as travel vaccinations.
“This program provides travelers with destination-specific information, including potential health risks, basic country specifics, personal safety information, and the necessary immunizations and medications to keep travelers safe and healthy abroad,” said Ryan Bender, Pharm.D., director of clinical services for Hometown Pharmacies and manager of the Hometown Pharmacy location in Rio, Wisconsin.
Outside of the Safe Travels program, all of the Hometown Pharmacy locations also administer seasonal flu shots and vaccinations against shingles, pneumonia, hepatitis B, HPV, tetanus, diphtheria and pertussis. “Providing immunizations is a service our patients appreciate,” Bender said. The pharmacy started its vaccination program in 2006.
If you don’t already provide vaccines and immunizations at your community pharmacy, you might want to consider this emerging area.
The majority of patients still get vaccines at doctors’ offices, but increasing numbers are heading to the pharmacy. Early estimates of the 2012-2013 flu season show that 34.5 percent of adults went to doctors’ offices to get their flu shots, while 18.4 percent visited a pharmacy, according to the Centers for Disease Control and Prevention.
As more patients choose to receive vaccines at pharmacies, it’s time to get ahead and start providing vaccination services now—before patients ask and you don’t have these services. The big box store and national chain pharmacies are all actively providing and marketing vaccines and immunizations, particularly flu shots. “It’s starting to be something people expect from their pharmacy,” said Forrester of D&H Drugstore.
Besides keeping up with the competition, an immunization program also offers a good source of revenue. Last year D&H Drugstore provided around 800 flu shots and 300 Zostavax shots. “It will be interesting to see what going from two nurses with limited availability to adding six pharmacists will do to those numbers,” Forrester said.
Unlike third party reimbursements for traditional prescriptions, providing vaccinations is a service your pharmacy can usually earn a decent margin on. Medicare reimburses for pneumonia and influenza vaccinations, Medicaid reimburses for children to receive influenza and other vaccinations and some commercial health insurance payers provide reimbursements for select vaccines. Let patients know what health insurance providers you do and do not accept. Also, be sure to check with your third party network or review your PBM contracts for this year’s vaccination schedules.
In cases where insurance doesn’t cover patients’ vaccinations, they’ll have to pay out of pocket. It’s a good idea to let these patients know that they can get their vaccines and immunizations less expensively at your pharmacy than through their doctor’s office.
Patients like going to their pharmacy to get vaccines because they often get charged less than they would at their doctor’s office. “For flu shots, there is no appointment necessary at our pharmacies and the cost to patients is the same or lower than what they would pay at their clinic,” said Bender of Hometown Pharmacies.
It isn’t all about cost-savings though. Many like the convenience factor pharmacies provide. Community pharmacies often offer extended store hours. When doctors’ offices only stay open 8 a.m. to 5 p.m., going to the pharmacy to get vaccinations becomes the more convenient choice for patients.
The easier access and lower costs of vaccines and immunizations at community pharmacies give patients more reasons to come to your store. And that means more business for you. “Some patients who get vaccines are our regular customers and some are people coming through our doors for the first time,” Bender said.
Vaccine and immunization services drive additional business, but they also contribute to a higher calling. They enable you to further improve your patients’ health.
Your patients likely visit your pharmacy more often than they visit their doctor. An American Pharmacists Association estimate showed that the equivalent of the entire U.S. population visits a pharmacy each week. As such an accessible touch point for their patients, pharmacists are in the unique position to serve as advocates for vaccines and immunizations.
You can easily integrate immunizations into the other patient care services you provide. Remind patients who you see regularly for blood pressure monitoring or diabetes education that they need to get their flu shot, for example. You can also help support completion of vaccines that require multiple doses. When a mother comes in for a refill and you noted that her daughter needs the last dose of an HPV vaccine, you can remind her about it. Pharmacists are also better able to identify high risk patients based on their medications and let them know that they need to get their immunizations.
“Immunizations are a very important part of the health of our communities,” Bender said. “Our pharmacies are located in small towns and provide a safe and convenient place for our patients to obtain this valuable health service.”
For pharmacists who have been practicing for a number of years, immunizations might still seem outside the realm of pharmacy. But the data suggests that it’s a trend that isn’t going away anytime soon. “I learned about it 40 years ago in pharmacy school, but it was one of those things that you never thought would concern you,” said Forrester of D&H Drugstore. “You didn’t think it was going to be a big deal for what your future practice was going to be.”
“Today all of the students have been trained in immunizations in the pharmacy schools,” he said. “That leads me to believe that the profession needs to endorse this and we all need to step up and be a part of this valuable process.”
Launching a successful immunization program requires multiple elements. Pharmacists have to undergo extra training and maintain CPR certification. Your physical store needs a private area to administer the vaccines and you need a marketing program to let patients know about this service. Here are a few resources to help you get started.
American Pharmacists Association
Tips and information for pharmacy-based immunization delivery
Centers for Disease Control and Prevention
News, clinical resources, patient education information and immunization training
Immunization Action Coalition
Handouts for patients and staff, coding and billing information, storage and handling recommendations
State Boards of Pharmacy
Check with your state board of pharmacy for immunization training information and state-specific requirements