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Expanding Rx’s vaccination role

BY Richard Monks

As patients across North America continue to turn to their neighborhood pharmacy for vaccinations, state and provincial governments in the United States and Canada are widening the range of immunizations that can be administered by a pharmacist.

(For the full report, including charts, click here.)

“There’s been a recognition that pharmacists play a valuable role in maintaining patients’ health,” American Pharmacists Association chief strategy officer Mitchel Rothholz said. “Public health officials around the country have come to see providing vaccines as a critical component of that role.”

While all 50 states allow pharmacists with immunization training and certification to administer some vaccines, a handful continue to restrict pharmacists to providing just flu shots and a limited number of other immunizations.

All told, 43 states, the District of Columbia and Puerto Rico allow pharmacists with an existing prescriber protocol to administer any vaccine approved by the Centers for Disease Control and Prevention. Of these jurisdictions, however, 18 mandate that a patient have a prescription. In some cases that requirement is limited only to patients younger than 18 years old.

In Canada, six of the country’s 13 provinces and territories allow pharmacists to administer flu vaccines with some jurisdictions also permitting them to provide other immunizations.

Meanwhile, regulators across the United States continue to loosen restrictions on pharmacist-administered vaccinations.

In Louisiana, for instance, a bill introduced last month would let pharmacists administer all immunizations and vaccines without a prescription to patients older than 17 years.

That proposal comes on the heels of several other changes to state laws over the past year that have expanded pharmacists’ role in immunizations.

Among those moves, the one that has impacted the greatest number of patients has been California’s expansion of pharmacists’ scope of practice. The law, which went into effect in October, makes pharmacists in the state a more central part of a patient’s healthcare team, and authorizes them to administer drugs and routine vaccinations.

That same month also saw North Carolina begin to let pharmacists vaccinate against pneumonia, shingles, hepatitis B, meningitis and tetanus. Previously, they were only authorized to administer flu vaccines.

“States are making the right decisions,” National Association of Chain Drug Stores VP of media relations Chrissy Kopple said. “We anticipate that will continue to be the case.”

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Officials: Immunization rates ‘woefully low’

BY Richard Monks

With public health officials calling the number of people receiving crucial immunizations woefully low, physicians and pharmacists across North America are working to get more people vaccinated.

“Because many vaccine-preventable diseases are not common in the United States, often people do not see the devastation it can cause until there is an outbreak,” said Karen Staniforth, group VP pharmacy initiatives and clinical services at Rite Aid. “It is important that we continue to protect our communities with vaccines because outbreaks of vaccine-preventable diseases can and do still occur in this country.”

According to researchers, the country’s declining vaccination rates are having the greatest impact on adults. A study published earlier this year in the journal Annals of Internal Medicine found that an average of 30,000 people in the United States die every year from vaccine-preventable diseases — mostly influenza — with more than 95% of these fatalities occurring in adults.

Researchers estimated that only 62% of people ages 65 years and older receive a pneumococcal vaccine, and just 65% get an influenza vaccine. Only 16% of those older than 60 years receive a herpes zoster vaccine, and just 20% of high-risk adults between 19 years and 64 years get a pneumococcal vaccine.

Since the start of the year, the impact of not enough people getting vaccinated has become front-page news in some areas of the country where sharp spikes in the number of cases of measles and pertussis are being reported. Pharmacies across the country have responded to these outbreaks by expanding the number of stores offering vaccines for these diseases and extending the hours during which they administer the immunizations.

Walgreens divisional VP of immunizations Catherine MacPherson said that giving patients greater access and availability has led to nearly a third of the vaccinations in its pharmacies being administered in the evening, on weekends and on holidays.

“We’ve demonstrated through our flu shot program and other immunization services the ability to have an impact on immunization rates as a key driver to helping improve population health in the communities we serve,” she said.

Immunizers say the key to increasing vaccination rates is driving home the message that vaccines provide a safe and inexpensive way to help patients stay healthy.

“There is a lot of confusion and misinformation about vaccinations in the marketplace,” CVS Caremark VP of pharmacy affairs Papatya Tankut said. “It is important that healthcare providers and practitioners, as well as such agencies as the CDC, continue to communicate publicly with a consistent message about the importance and safety of getting vaccinated.”

Advocates of pharmacist-administered vaccinations say that as the country’s healthcare system continues to evolve, pharmacists’ ability to provide vaccinations fits well with their expanding role in managing patients’ health.

“There is a growing recognition in the healthcare community that pharmacists have a valuable role to play in helping the nation achieve its goals in this area,” American Pharmacists Association chief strategy officer Mitchel Rothholz said. “As the healthcare system moves more toward a team-based model, pharmacist-administered vaccines make more sense.”

While much of the resistance to pharmacists administering a wide range of vaccines has eroded, some in the medical community continue to call for restrictions. In Pennsylvania, which last year lagged behind the national median for immunizations of school-age children, the Pennsylvania chapter of the American Academy of Pediatrics, the Pennsylvania Medical Society and the Pennsylvania Academy of Family Physicians have criticized a recent legislative proposal to lower the age at which pharmacists can provide immunizations. The groups say that doctors are best qualified to deal with a negative drug reaction, should one occur.

Proponents of expanding the scope of pharmacist-administered vaccines, however, say they are confident that such opposition will disappear as more evidence emerges about the impact pharmacists can have on immunization rates and public health.

“The perception of the role of pharmacists has improved over the past several years,” Rothholz said. “As there is more documentation of what pharmacists can do in this area, any remaining barriers to pharmacies providing vaccinations will disappear.”

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Walmart debuts new clinic concept

BY DSN STAFF

Walmart executives hosted a series of store tours and briefings in advance of its company shareholders meeting in June, reported DSN sister publication Retailing Today. “Walmart opened its first owned health care clinic in Copperas Cove, Texas, recently and introduced a pricing model eerily similar to the flat rate $4 and $10 generic drug programs launched eight years ago,” noted editor Mike Troy. “Except in this case, Walmart associates can see a primary care doctor at the clinic for $4 and customers pay $40.” The clinic will serve about 4,500 employees who work in proximity to the store, according to Labeed Diab, Walmart’s president of health and wellness.

For more on Walmart’s annual shareholders’ meeting, including 10 key takeaways for suppliers, visit http://bit.ly/1oOrEwE.

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