When the going got tough, the tough — in this case retail pharmacies across the country — got going.
As we have seen over the last month, retail pharmacies are playing a significant role in the administration of COVID-19 vaccines, leveraging their extensive experience in offering vaccinations against other diseases, as well as their strong relationships with their local communities.
“Frankly, we see this as an exciting time for our nation’s pharmacies,” said John King, CEO of Omnisys, a Dallas-based technology company that works with pharmacies. “And, we think that what is going on right now is going to be a great catalyst for change as more retailers realize the importance of their pharmacies to the general public. Covid showed that there is a shortage of primary care doctors and that the pharmacy will have to step up to help fill that void.”
Even with the excitement there were some glitches. While operators have spent months preparing their systems and personnel for the vaccine rollout, mass retailers have been at the mercy of the lengthy drug approval, manufacturing processes and distribution of the vaccines.
“The limited supply of the vaccine has been our biggest challenge,” said Aaron Wiese, executive vice president and chief health officer at West Des Moines, Iowa-based Hy-Vee. “We would love to vaccinate every single person that inquires.”
The Federal Retail Pharmacy Partnership program kicked off on Feb. 11, with 1 million doses of COVID-19 vaccine distributed to 6,500 pharmacies across the country. That supplemented previous distribution of vaccine doses that had been conducted at the state level.
The federal program is expected to expand to include more retail pharmacies as more doses become available. The potential exists for the nation’s approximately 40,000 retail pharmacies to begin offering vaccinations when the supply level increases, said National Association of Chain Drug Stores president and CEO Steve Anderson, who noted that 90% of Americans live within 5 miles of a pharmacy.
“Ultimately, NACDS members can meet and exceed the 1 million vaccinations a month threshold, yet it’s important to understand the supply of vaccines remains the rate-limiting factor in the vaccination effort,” Anderson said. “Pharmacies across America are prepared and have the experience to turn vaccination doses into vaccination appointments, and that will continue to ramp up as more vaccines become available.”
Both chain and independent pharmacies have joined the state and federal programs, which identified pharmacy locations based on the anticipated needs of the populations in each area. Independent pharmacies have the opportunity to join the federal program through their network administrators.
“All the pharmacies are ready to go,” said Kurt Proctor, senior vice president of strategic initiatives at the National Community Pharmacy Association. “We’ve got a very well entrenched, good distribution system that patients have preferred for years now to get their vaccines and, at this point, it’s very underutilized. Hopefully, pharmacies will be utilized more and more as the volume of vaccine supply increases.”
Many independent pharmacies have been involved in both the state and federal programs, he said, and more are expected to join as the supply of vaccine increases.
While obtaining enough doses to administer vaccines has been difficult and frustrating for retail pharmacy operators, the COVID-19 vaccine also poses some unique logistical challenges. The first two vaccines, from Pfizer and Moderna, must be stored frozen and must be used within a certain time frame or be discarded. In addition, both require a series of two shots — 21 days apart in the case of the Pfizer vaccine and 28 days for the Moderna vaccine — which adds to the complexity of scheduling and record keeping.
“Everything under COVID is different [from other vaccinations] in some ways,” said Mitch Rothholz, chief of governance and state affiliates and immunization policy lead at the American Pharmacists Association. “The process of actually giving the injection is the same, but the steps leading up for storage and handling, documentation, the use of [personal protective equipment], social distancing, and so on — that’s all different than in other vaccination activities.”
The biggest challenges in the early days of the vaccine rollout have been around managing scheduling and patient expectations, he said. That’s especially difficult, considering the uncertainty about ongoing replenishment of the dosage supply.
“The demand is amazing, and that’s part of what the system is trying to manage,” Rothholz said. “One thing that we don’t want to do as pharmacists is to promise something to a patient and not be able to deliver.”
Because of the two-shot process, as well as the expected rollout of a single-shot vaccine in March and additional vaccines to follow, strong record-keeping systems also are critical, he said.
Jared Tancrelle, vice president of store operations at CVS Health, said the vaccine rollout has a lot of moving parts that require careful management at the store level.
“As the first two approved vaccines were in development, the initial challenge we faced was that each required different and special storage requirements, and that both required two doses to be effective, with different times between each dose,” he said. “We’ve also dealt with state-specific and varying eligibility requirements, which caused different populations to become eligible at different times and in different locations. This caused confusion for customers. Another initial challenge was sourcing vaccine from two sources — state and or local and federal.”
The company leveraged the end-to-end digital experience that it has had in place for flu vaccinations and for COVID testing, and adapted it to use in the COVID vaccine administration process, Tancrelle said. The digital scheduling mechanism allows CVS Pharmacy to match information entered by the customer against state eligibility criteria, ensure customers schedule both required doses in the recommended timeframe, send text and email reminders in advance of upcoming vaccine appointments, and provide real-time appointment availability on cvs.com, he said.
Last fall, CVS Health announced the hiring of 10,000 pharmacy technicians and other healthcare workers to support its COVID-19 response efforts, including vaccinations. This move was based, in part, on the updated federal authorization of certified pharmacy technicians to deliver vaccine under supervision of onsite pharmacists, Tancrelle said.
CVS Health also hired pharmacists in certain geographies, based on the concentrations of long-term care facilities that selected CVS Pharmacy as a COVID-19 vaccination partner, he said.
“When COVID-19 vaccines are widely available in our stores, we’ll have 90,000 healthcare workers, including pharmacists and pharmacy technicians, prepared to play a critical role in the vaccination process,” Tancrelle said. “We’ll continue to adjust our hiring levels to meet demand, which has been the case since the start of the pandemic.”
As more vaccine supply becomes available, he said he expects more CVS pharmacies to join the effort. “Since the start, we’ve refined and improved our process and will be able to scale at the pace of available supply,” Tancrelle said. “We anticipate there to be less consumer confusion as we work through the next stages, and eventually to the general population phase.”
In addition, scheduling and administration of vaccines should become smoother as state-specific eligibility criteria are reduced, he said. CVS Pharmacy locations throughout the country will have the capacity to administer 20 million to 25 million shots per month, if the doses are available, he said.
Hy-Vee created a COVID-19 vaccine landing page and an e-newsletter to keep its patients informed, Wiese said. The retailer also added a location finder component to its online scheduler and vaccine landing page to help customers identify where vaccines are available at its pharmacy locations.
Hy-Vee began meeting with local jurisdictions last fall “to ensure they knew we were eager to partner to serve the communities in which we operate,” Wiese said. The company also began operational planning, which includes weekly educational and operational meetings with pharmacy and store leadership to keep everyone up to date on clinical elements of the administration, training on handling the vaccine and the vaccine rollout.
He said it has been important for Hy-Vee to remain agile during the early stages of the rollout.
“At Hy-Vee, our goal is to be a partner that is able to adapt to the needs of the CDC, our local jurisdictions and — most importantly — our patients,” Wiese said. “As guidance and logistics change, we need to be able to adapt and change to serve. Having a robust internal digital development team has helped tremendously to quickly update and adapt our tools for customers as guidelines change.”
He also said that in areas where it is permitted, Hy-Vee has added nursing staff to its pharmacy teams to assist with vaccination efforts.
“Today our immunizing workforce exceeds our supply,” Wiese said. “Nothing is more exciting to Hy-Vee than the future outlook of having ample vaccine supply to be able to immunize every individual who wants a vaccine within our communities. Our pharmacists and technicians consider it a privilege to be part of this historic effort to vaccinate our communities and help to bring an end to this global pandemic.”
Managing Patient Expectations
Vic Vercammen, chief pandemic officer at Pittsburgh-based Giant Eagle, said managing patient frustration over the relatively slow rollout of the early vaccine doses has been a significant challenge.
“We have worked to maintain transparent communication with Giant Eagle Pharmacy patients as we reassure our communities that we are opening additional vaccine appointments as supply becomes available to us,” he said.
Vercammen also said the chain had administered more than 84,000 vaccinations at its 200 in-store pharmacies by mid-February.
In preparation for the rollout, the chain launched an online scheduling tool that patients can view and schedule available vaccination appointments.
“From the early stages of the vaccine rollout, we have recognized the importance of being a source of trustworthy information for our communities,” Vercammen said. “We have taken steps to share reliable vaccine-related resources on our website and continue to have our pharmacists available to address patient health concerns and questions.
“As we continue to work through the different stages of the vaccine rollout, we look forward to continuing to play a leading role in vaccinating our communities,” he said.
Cincinnati-based Kroger also created a scheduling tool to help patients book vaccination appointments. The new tool can manage more than 250,000 requests daily, the company said, and will reflect the amount of vaccine doses confirmed within Kroger’s system.
Like many of the appointment-scheduling systems that have emerged during the vaccine rollout, the system screens users for their eligibility and then creates appointments.
In addition, Kroger Health’s COVID-19 vaccine support call center has partnered with IBM Watson to create an AI-powered phone experience. Watson will share answers to frequently asked questions and reduce the wait time for patients, making appointments by transferring them to a care representative as needed.
As of Feb. 16, Kroger Health had administered more than 380,000 COVID-19 vaccines in 25 states to essential healthcare workers, skilled nursing facilities, elderly populations, educators and eligible employees. The company was administering vaccines at 1,300 of its 2,200 pharmacies, and noted that if all of its pharmacy locations begin to receive doses of the vaccine, it could administer an average of nearly 500,000 vaccinations per week.
“Kroger Health’s priority is the safety of our customers, associates and communities,” said Colleen Lindholz, president of Kroger Health. “Thanks to our incredible team of health professionals and technology experts, we’ve been able to streamline the vaccine rollout process across our family of pharmacies during these ever-changing times. As more vaccines become available nationwide, our pharmacies and clinics will be ready and able to administer thousands of doses to our communities every day. Our new online scheduling tool and improved call center experience will allow us to easily scale to meet demand once more vaccine doses are available to Kroger Health.”
Deerfield, Ill.-based Walgreens was one of the first retail pharmacies to begin administering COVID-19 vaccinations in December to long-term care facility staff and residents. “Our pharmacy teams have already provided nearly 2 million COVID-19 vaccinations and stand ready with their expertise to help educate and vaccinate additional Americans, including those in rural and underserved communities,” said the chain’s president John Standley in a statement.
Camp Hill, Pa.-based Rite Aid also is participating in both the state and federal vaccine programs. The company said it anticipates providing vaccinations in all of its locations once supply is available. “With vaccine demand outpacing supply, the establishment of an additional channel for vaccine allocation and distribution is an important and positive first step in the effort to end COVID-19,” said Heyward Donigan, president and CEO of Rite Aid, when it was announced that the chain was part of the federal program that launched on Feb. 11. “We expect to see availability of the vaccine improve over time, and Rite Aid stands ready to administer as many vaccines as we are allocated quickly, safely and efficiently.”
One way retail pharmacies can ensure they are administering the vaccines properly and meeting all the criteria set by the CDC is by obtaining certification. The Compliance Team, which launched its first pharmacy certification program last year to certify COVID testing operations, has now expanded that effort to vaccine administration.
As pharmacies prepare to activate more locations for vaccine administration, it may behoove them to have a third party ensure that they are following all the proper protocols. In addition, as pharmacy operations are audited in the coming months to ensure that they have followed protocols, The Compliance Team can verify that proper procedures are being followed with regard to the handling of the vaccine itself, the management of the patient flow and the record keeping, among other aspects of vaccine administration.
Having third-party certification might also help pharmacies overcome consumer hesitancy about getting the vaccine, said Sandra Canally, founder and CEO of The Compliance Team.
“Even though they trust their neighborhood pharmacist — that’s a given — this is just that extra assurance to the community that safety and quality has been validated by a third-party accreditor,” she said.
The Compliance Team evaluates pharmacies remotely by having them upload their operating procedures to the company’s portal and then conducts a video conference during which it can review the facility to ensure that it is set up properly. It was the first company to set up remote accreditation for COVID testing, which it has been conducting for the past year.
“Pharmacies have been doing vaccinations for the flu, shingles and many other things for years, but this mass immunization for COVID can be truly challenging,” Canally said. “But we have a lot of really good pharmacies out there, and they truly are community leaders. If anybody can get it done, the neighborhood pharmacy can get it done.”
NCPA’s Proctor said pharmacies have appreciated the opportunity to participate in the nationwide effort to administer COVID-19 vaccines.
“We’re hearing how rewarding this is for the pharmacy, after all the struggle and the effort they’ve gone through,” he said. “Nobody’s going to make a ton of money on this, but they are so overwhelmed by the positive response that they get from patients that it’s been professionally rewarding.”
“I think there will be lots of things from this that are going to spill forward, and that becomes part of standard practice,” Proctor said. “That it’s going to be good for the profession and for patients.”
King from Omnisys was just as direct. “No one is more trusted, affordable and convenient than the pharmacy,” he said. “We do not see any way forward without the pharmacist being involved.”