Cost, perception remain barriers in pharmacy-based vaccination

Adult vaccination rates are historically low in the U.S., and both cost and access have a lot to do with it.

Stakeholders have called for increased access, such as through pharmacy-based vaccination programs, but a new report verifies that cost is prohibitive and keeps patients from utilizing those services.

In a new report titled, “Opportunities and Challenges of Adolescent and Adult Vaccination Administration within Pharmacies in the United States,” and published in Biomedical Informatics Insights, researchers sought to identify factors that promote or deter pharmacy-based vaccinations for teens and adults. The research team focused on human papillomavirus (HPV); tetanus, diphtheria, and pertussis (TDAP); or meningitis (meningococcal conjugate vaccine [MCV4]), influenza and pneumococcal vaccines. Three quarters of the pharmacists that participated in the study reported that vaccination rates could be increased, and that insurance coverage, patient education, and pharmacist’s time constraints were common challenges.

Pharmacies, according to the study, may be particularly useful as a way to reach populations with limited access to a traditional physician’s office, as well as the flexibility and extended hours a pharmacy could offer.
Study details

The pharmacists polled in the report generally had two to three pharmacists on staff at their location to deliver vaccines in a designated area. All offered walk-in appointments, 53% allowed appointments during business hours, 38% offered mass clinics and 78% offered vaccination services at off-site locations. As far as vaccines offered, 80% of pharmacists provided the Tdap booster, 60% provided the MCV4 vaccine and 45% provided the HPV vaccine to adolescents. All 40 of the participating pharmacists offered herpes zoster. In addition, all 40 pharmacists reported administering shingles and flu vaccines to adults.

All of the pharmacies accepted Medicare, self-pay methods, and private insurance. Another 98% accepted Medicaid, 65% accepted TriCare, and 60% participated in the Children’s Health Insurance Program (CHIP) with more than half of the pharmacists participating in the Vaccines for Children program.

More than half of the pharmacists polled described reimbursement available to their clients as a challenge, and 57% reported that insurance reimbursements were inadequate to cover vaccine administration costs for all vaccines and insurance plans, according to the report. The time of the pharmacist administering the vaccination was often not covered or reimbursed by payers, and 53% of pharmacists said they could not determine if a patient’s insurance covered a pharmacy-administered vaccine. Another 13% of pharmacists had to refer patients to a traditional physician’s office due to reimbursement policies.

While 78% of pharmacists reported reimbursement and insurance issues as the greatest challenge to vaccination, 43% also cited having a designated administration area and the cost of storing vaccines to be an issue and 40% said patient education was a challenge. Pharmacists reported that patient concern over uncovered costs were also a big deterrent.

Next: The role of primary care physicians 

The role of primary care physicians

The report suggests that PCPs help pharmacies overcome at least some of these hurdles since a physicians’ recommendation is the strongest predictors of vaccine uptake, according to the report. A quarter of the pharmacists in the study reported that collaboration with doctors was an important component of a successful vaccination program, especially with teens.

There are barriers even to physician support, according to the study, which referenced a 2003 report in which 75% of family physicians in North Carolina were unaware that their state allowed pharmacists to administer vaccines. Additionally, while half of physicians in a prior study believed pharmacists were equipped to administer the flu vaccine, other vaccines received less support. Another concern among physicians is the lack of documentation they receive when a vaccine has been administered, according to the report.

This is where collaborative efforts to improve documentation could come into play, according to the report.

Partners to increase vaccinations

Jessica Yasmine Islam, MPH, a doctoral student in the department of epidemiology at the Gillings Schools of Global Public Health at the University of North Carolina at Chapel Hill co-authored the study and said primary care physicians and pharmacists both play a vital role in vaccination. They should work to make certain that individual vaccination coverage is included in electronic record reporting to both insurance and state vaccination databases, she said.

“Pharmacy-based vaccination augments traditional vaccine channels to reach populations of the community who may experience barriers to obtaining traditional health care due to lack of insurance or knowledge,” Islam told Medical Economics. “Overall, pharmacists are uniquely positioned to recommend vaccination to a broader patient population and also, provide vital knowledge on its importance due to their accessibility.”

Islam said reimbursement problems at the pharmacy level result in missed opportunities to improve national vaccination rates. Both improved insurance coverage for vaccine administration and information systems for reminders and multiple dose provision are needed to improve vaccine uptake, according to the report. Islam said she hopes the study findings will motivate pharmacists, PCPs and policymakers to collaborate to find new ways to expand the pharmacist’s role in providing vaccinations.