Pharmacist-administered immunizations: What does your state allow?

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Three U.S. maps of immunization laws by state

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As trusted and highly accessible health care providers, pharmacists are well positioned to increase the public’s access to immunizations. The use of pharmacists to administer immunizations has evolved rapidly over the past 2 decades. In 1995, only nine states allowed pharmacists to immunize. Today, pharmacists have authority to administer immunizations in all 50 states, the District of Columbia, and Puerto Rico.1,2 Although the extent of pharmacists’ authority varies by state, great progress has been made in modernizing states’ scope of practice laws and regulations to allow pharmacists to increase immunization rates across the lifespan, while working in coordination and collaboration with the rest of the immunization neighborhood. 


Advancements in pharmacist administration authority have largely occurred in three areas of activity: expanding the types of vaccines that pharmacists can administer, decreasing the age of the patient to whom a pharmacist can administer a vaccine, and increasing the autonomy of the pharmacist in the process of immunizing.


Background 


Many states initially authorized pharmacists only to administer the influenza vaccine. That authority has vastly expanded in most states. Nearly all states now allow pharmacists to administer all or almost all vaccines, including routine adult vaccines like herpes zoster and pneumococcal and travel vaccines. Since 2012, seven states have allowed pharmacists to administer all vaccines. Ohio and Florida were the most recent to make this change, enacting changes in 2015. Currently, pharmacists can administer any vaccine in 46 states plus the District of Columbia and Puerto Rico. 


In the early 1990s, it was envisioned that pharmacists could be utilized to increase access to childhood and adolescent vaccines.1 As states authorized pharmacists to administer vaccines, however, they often began by allowing only adults to receive this service. As policy makers and the public became more comfortable with the idea of pharmacist-provided immunizations, and a need was recognized among the adolescent and pediatric populations, it was apparent that the impact made in increasing immunization access for adults could also enhance access for adolescent and child populations, where needed. In June of 2012, only 13 states allowed pharmacists to administer a vaccination to any age patient. As of July 2015, 27 states—more than double!—now have this broad authority. Pharmacists continually are engaged with immunization information systems or registries and other mechanisms to document administered vaccines.


In addition to expanding types of vaccines and the patient age to whom pharmacists may administer vaccines, states also are authorizing pharmacists to take a greater role in screening, recommending, and prescribing vaccines. Through the years, many states’ laws have evolved from requiring a prescription from a physician for the pharmacist to administer vaccines, to allowing for protocol-based administration, to some states finally allowing pharmacists to serve as the vaccine prescriber. By allowing for an additional health care provider—in this case a pharmacist—to serve as the screener, recommender, prescriber, and administrator of the vaccine, access is increased, and patients are more likely to actually receive the vaccine that is recommended for them. As of July 2015, eight states allow pharmacists to prescribe or administer, without a prescription, all recommended vaccines (many states don’t allow this for young children); and another nine states allow this for the influenza vaccine. 


How pharmacists can help


Pharmacists can help improve immunization rates by assessing each patient for their immunization status, recommending and offering or referring for any immunizations that may be needed, in accordance with the NVAC (National Vaccine Advisory Committee) Adult Immunization Standards. In states where progress still needs to be made, pharmacists should join and engage with APhA and their state pharmacy association to advocate for the needed changes. 


Learn more in APhA’s Immunization Center on pharmacist.com.
 

References


  1. J Am Pharm Assoc. 2006;46:168–182 

  2. www.pharmacist.com/sites/default/files/files/Pharmacist_IZ_Authority_1_3...
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