Pharmacies fill public health need as vaccination centers


Beset by rising costs, a fast-growing elderly population and a critical shortage of primary care doctors, the nation’s health system is desperately in search of ways to lower costs through disease prevention and better access to quality care. And one of the most effective tools for preventing disease among millions of Americans has been the expansion and widespread availability of vaccinations within tens of thousands of community pharmacies.

More than 200,000 of the nation’s roughly 300,000 pharmacists — including virtually all pharmacists employed by Walgreens, CVS Health, Rite Aid and Walmart — have been extensively trained and certified to provide vaccinations for influenza and a variety of other conditions. And those pharmacists have been authorized to provide at least some vaccination services in all 50 states and Puerto Rico.

“Highly educated to provide patient care services, pharmacists are well suited to help increase vaccination rates and further reduce the incidence of vaccine preventable diseases,” notes the National Association of Chain Drug Stores.

According to the U.S. Centers for Disease Control and Prevention, roughly 1-in-5 of all vaccinated adults in the United States now get their flu shot at a pharmacy. That added up to some 25 million doses in the most recent flu season, and it makes pharmacies the most common place to get influenza vaccination outside of doctors’ offices and other medical facilities.

That’s a testament to pharmacy’s ability to develop solutions to the health system’s urgent need for cost-effective, accessible sources of preventive care. And it’s a remarkable accomplishment in its own right: just seven years ago, only a handful of pharmacists immunized patients for anything, even influenza.

“Today it is very common for people to get vaccinated in a pharmacy from the pharmacy professional,” said Kermit Crawford, executive in residence at the University of Southern California School of Pharmacy and former president of pharmacy, health and wellness for Walgreens. “It’s more convenient ... and it’s absolutely at a more affordable cost than going to the physician’s office.”

Cost is one of several factors driving the shift in vaccination delivery. Indeed, immunization programs conducted in a pharmacy versus a doctor’s office save an average of about $31 per patient, one study found.

Public and private health plans and payers — including the federal government — have embraced both the cost savings and the expanded patient access offered by pharmacist-provided vaccinations. The Department of Defense, for instance, has boosted coverage of the portfolio of vaccines that beneficiaries of the TRICARE military health plan can obtain from community pharmacies to include all CDC-recommended vaccines.

Behind that decision: potential estimated savings of $1.5 million for the first six months of the pharmacy-administered vaccination program. “Significant savings were achieved ... when policies were implemented to allow TRICARE beneficiaries to obtain flu and pneumococcal vaccines from retail pharmacies,” NACDS stated.

Besides lowering health costs for payers, pharmacies have also been instrumental in the effort to make immunizations more accessible to people where they live and work. One way to boost availability of vaccines and reduce incidence of flu, noted the CDC in a report, is “expanding access through use of nontraditional settings for vaccination [e.g., pharmacies, workplaces, and schools] to reach persons who might not visit a physician’s office during the influenza season.”

Efforts by national and regional pharmacy providers to expand vaccination services and remind Americans of their importance has helped raise awareness and national immunization rates for flu, whooping cough, tetanus and other infectious and common diseases. Those “collective efforts,” the Department of Health and Human Services reported, “have made a tremendous contribution to raising awareness and increasing access to vaccines.”

“Your ability to target recommendations based on patients’ health conditions [like] diabetes, heart disease, asthma and pregnancy, has significant potential to ensure vaccination of those at highest risk of severe illness,” the agency noted in an open letter to pharmacists. “Research shows that your recommendation is vital to patients receiving needed vaccines.”

Noting that “pharmacists have been instrumental in increasing the vaccination rate in the U.S.,” federal health agencies including the CDC have “specifically asked the pharmacy community for their continued support and efforts to help address vaccination needs in their local communities,” NACDS noted. “This is especially vital in rural and some suburban areas with limited physician access.”

What’s more, a study published in the Annals of Family Medicine found that nearly one-third of adults get vaccinations after hours, “when traditional vaccine providers are likely unavailable,” noted NACDS.

The question of access isn’t just a key plank in the nation’s healthcare framework: it’s critical to efforts to prevent or reduce disease and to lower health costs by billions of dollars. According to the CDC, flu vaccines prevented 5 million cases of influenza and 40,000 hospitalizations in a single year.

In the 20th century — dubbed “the century of vaccines” by the Department of Health and Human Services because of their impact on health and longevity — “The life spans of Americans increased by more than 30 years in large part because of vaccines, and mortality from infectious diseases in the United States decreased 14-fold,” HHS noted in its National Vaccine Plan. “A child born in the U.S. today can now be protected against 17 serious diseases and conditions through immunization.”

Increasingly, patients themselves are embracing pharmacies as a vaccination destination. In a recent survey from Rite Aid and the National Foundation for Infectious Diseases, 79% of women polled said they would find an immunization evaluation from a pharmacy helpful.

“There is clearly a need to educate consumers and raise awareness about the importance of vaccinations,” said Robert Thompson, Rite Aid EVP pharmacy.

Pharmacy providers like Walgreens are also harnessing the power of information technology to expand the benefits of their vaccination programs and connect them to the broader goal of a healthier America. Electronic health records and an “adult immunization assessment” provided to all those who receive vaccinations at Walgreens “give our pharmacists the ability to create a profile for their patients for all of their vaccines,” said Crawford.

“We’ll be able to notify the patient when they’re due to get a vaccine, and who’s eligible to get those vaccines,” he said recently. “This will allow our pharmacists to play a greater role in the prevention of disease.”

“All 27,000 of our pharmacists ... are certified immunizers,” Crawford added. “And that’s continuing to expand into other immunizations and vaccines. With this platform, we’re able to reform how health care is delivered in this country when it comes to flu shots. And that’s what pharmacy is about.&rdqu

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