Immunizations: A shot in the arm for pharmacists

Growing demand for immunizations creates excitement, opportunities

Pharmacists Richard and Marla Trepanier at the Medicine Shoppe Pharmacy in Benson, AZ, have administered about 1,000 influenza vaccinations since the season began in September. This husband-and-wife team is but one example of how community pharmacists are expanding their patient care services, thereby creating additional  revenue streams and growing their patient base through addressing the health care needs of these individuals through providing immunizations and other services. Richard began immunizing patients a few years ago after completing APhA’s Pharmacy-Based Immunization Certificate Program and has embraced adding this service to his repertoire.

“The way I practiced when I first graduated from school is far different than today,” he said. “I have techs to pour the prescriptions. Now I am talking to people about disease management and offering immunizations. Pharmacists now are offering really valuable services for people seeking medical help.”

Pushed by a pandemic
The ability to administer immunizations to the masses became extremely important during 2009's A/H1N1 influenza pandemic. And pharmacies have been aligning all of their resources, including pharmacists and nurse practitioners, to be on the forefront of offering this services to patients.

“Niche services like immunizations are a great way for community pharmacists to diversify their revenue while strengthening relationships with patients,” Mark DeLorenzo, Vice President of Marketing and Product Management at Cardinal Health, Medicine Shoppe’s parent organization, said. “Patients benefit by having convenient, local access to an important health care service. Pharmacies benefit from additional store traffic, diversified revenue, and the opportunity to capture additional prescription, over-the-counter, private label, and front-of-store purchases.”

Millions of Americans immunized
One of the largest chains to offer immunizations is Walgreen Co., with a network of more than 18,000 pharmacist and nurse practitioner immunizers. They began 5 years ago with a pilot program in two markets and now offer the service in all of their stores across the nation.

Demand for this year’s seasonal flu shots was “unprecedented,” according to Jim Cohn, the company’s media relations manager. Walgreens administered 5.4 million seasonal flu shots during a 2-month period (up from 1.2 million during the previous year’s entire season). Cohn said they administered 1 million doses in just the first 2 weeks after product became available. He estimates this was likely due to a doubling in the number of individuals providing immunizations this year, as well as an increased awareness that resulted from anxiety over the H1N1 pandemic.

“In September, we had a guarantee in every store that we would have flu shots and we let people know we were offering them,” said Ed Cohen, Senior Business Manager for Walgreens’ immunization services. “And we ran out. I don’t think there is anyone who would have anticipated as much demand as we had.”

Cohen said patients are quickly warming to the accessibility and ease of getting vaccinations from pharmacists. At one point, Walgreens was administering 50,000 doses a day; on New Year’s Day and Christmas Eve (when few other providers were available) they provided more than 15,000 vaccinations companywide.

Because of the dwindling supplies, Walgreens now only provides seasonal shots at Take Care Clinics. As of January, both pharmacists and clinics were offering H1N1 vaccines, of which they provided about 1.5 million vaccinations. The program began slowly due to the sluggish release of the vaccines, but company staff had no problem meeting demand once they received their full H1N1 supply.

Variable supplies
Many pharmacies saw spikes in demand for seasonal flu shots that were difficult to meet this season.

Rite Aid’s 2,000 immunizing pharmacists provided 84% more seasonal influenza vaccinations than in the previous year, according to a company news release. Demand slowed after a shortage of seasonal vaccine in late fall, but the company has since received enough doses of seasonal influenza vaccine to get through the remainder of the season.

CVS Caremark also encountered more demand than supply with their seasonal influenza vaccination program. The company offered vaccinations in their pharmacy, vendor, and Minute Clinic locations. Because of greater demand and delivery delays, CVS/pharmacies were forced to end their immunization clinics for seasonal influenza by the third week of October, said Mike DeAngelis, the company’s Director of Public Relations.

DeAngelis said the company has been focusing a lot of their vaccination efforts on their 500 Minute Clinics nationwide, where they are still offering seasonal influenza as well as H1N1 vaccination. They look more to these providers because nurse practitioners can offer vaccinations without an appointment 7 days a week.

“It is still a relatively new concept, but I think as it becomes more the norm, pharmacists will in turn become more comfortable with adding it to their regimen of services,” DeAngelis said. “It is an extension of the pharmacist’s role as the most available health care provider in the community.”

Providing vaccinations is voluntary for CVS pharmacists, and those who are interested are trained and certified through state associations.

APhA provides training template
The program that many associations, colleges, and pharmacy corporations are using is APhA’s Pharmacy-Based Immunization Delivery training. The certificate program, which began in 1996, offers self-study, a seminar, and hands-on assessment of injection techniques.

The organization licenses the program to many entities across the profession, resulting in more than 90,000 individuals being trained to assume the role as immunization provider. Currently, about 120 partners license the training. Shelby Englert, APhA’s Senior Director of Education, estimates the growth seen in immunization certificate training program participation during 2009 occurred because of the H1N1 concerns.

Because of the high demand, APhA has created an online system that allows some of its partners to get self-study materials and have participants complete testing materials via computer. The training program is updated several times per year, a process that includes the nation’s leaders in pharmacy-based immunizations.

AmerisourceBergen is one of the partners that trains pharmacists through the certificate program. Ceci Zeigler, National Director of In-Store Pharmacy Solutions, said they have seen demand grow greatly as well. In 2009, they offered 15 courses and trained 600 community independent and chain pharmacists. Because of growing interest, they plan to hold 18 courses this year.

Vaccines benefit patients, and pharmacies too
APhA has led the way toward establishing immunization services as an important patient care service offered in today’s pharmacy practice. Committed to supporting practitioners in this patient care role, APhA provides advocacy and practice support for pharmacists and pharmacies implementing immunization services into their practices. With more than 15 years of experience in this area, APhA’s staff and practice leaders provide more than education programs to its partners.

Englert said that providing immunizations is popular for a lot of pharmacists because it is an extension of what they are already doing---it is an easily understandable service and one for which they can be compensated.

Trepanier agrees. He says he treats immunizations like the rest of his workflow---someone comes in and is out in 15 minutes. He is able to charge for both the administration and a professional fee for the service, which helps his revenue “a tremendous amount.” The corporate offices recently sent a thank you note and coupon to all of the patients who had never been to his pharmacy before receiving a vaccination. Trepanier said 14% of those people later came back to have a prescription filled.

“[Offering vaccinations] is a new revenue stream with new customers coming in and I have had many repeats," said Trepanier.

—Tammy Worth (pt@aphanet.org)
Contributing writer

Posted February 2, 2010