Shifting Vaccinations to the Pharmacy Lowers Healthcare Costs

May 17, 2018 - Pharmacies can administer a wide range of vaccines to patients at significantly lower healthcare costs than physician practices and other medical settings, a new report from the Pacific Research Institute found.

The literature review showed that average direct medical costs paid per adult vaccination were 16 to 26 percent lower in pharmacies compared to physician practices, and 11 to 20 percent lower compared to other medical settings. The average direct medical costs included health plan and enrollee paid amounts for the vaccine, vaccine administration, dispensing fee, and visit costs.

On the heels of a particularly nasty flu season, healthcare stakeholders may want to consider allowing pharmacies administer more vaccines to cut healthcare costs. The analysis showed that the average direct medical cost paid per adult influenza vaccination was just $21.57 at the pharmacy versus $29.29 at a physician practice and $24.30 in another medical setting.

Other common vaccines were also cheaper when administered at the pharmacy. For example, an adult shingles vaccination had average direct medical costs of $168.50 at a pharmacy versus $208.72 at a physician office and $209.51 in another medical setting.

More robust vaccine administration in the pharmacy setting could help physician practices lower their medication costs.

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Currently, patients see their provider for the majority of vaccinations. Therefore, physician practices must stock common vaccines at all times to meet patient demand.

However, only 31 percent of family physicians and 20 percent of general internists reported stocking all 11 adult vaccinations that were recommended for routine use in 2012, a cited survey showed. Physicians said they did not carry all the vaccines because of the high costs of stocking and administering the drugs.

In addition to healthcare cost reductions, shifting vaccine administration to pharmacies may also improve vaccination rates and patient outcomes, the Pacific Research Institute stated.

Public health officials view current vaccination rates as too low. In a 2017 report, the Centers for Disease Control and Prevention (CDC) said: “adult vaccination coverage remains low for most routinely recommended vaccines.” In an effort to increase vaccination rates for several recommended vaccines, the CDC launched the Healthy People 2020 initiative. However, a recent study showed that vaccination rates for three of the four recommended vaccines in the initiative were under the target levels.

Pharmacies represent an opportunity to increase vaccination rates because they offer services at more convenient hours and locations, the Pacific Research Institute argued.

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“These convenience benefits have been linked to increased vaccination results,” the group wrote. “In fact, these improvements to vaccination rates were due, in part, to pharmacies providing vaccination services during non-working hours that are more convenient for many adults.”

About 30.5 percent of vaccines administered at a national pharmacy chain was done during nights, weekends, and holidays, a 2013 analysis showed. Approximately 17.5 percent of vaccinations were also administered during lunch hours, and uninsured patients were more likely to receive a vaccination during the off-clinic hours, another study uncovered.

The conveniences associated with pharmacies could particularly benefit rural patients. Patients in rural areas face healthcare professional shortages and long distance between physician practices and hospitals, making it difficult to see a primary care provider to administer vaccines.

Despite the healthcare cost and patient outcome benefits, pharmacies are up against several barriers when it comes to more robust vaccine administration.

All states allow pharmacists to administer vaccines to some extent as of 2017, but 33 states still limit vaccine administration at pharmacies. Common limitations include requiring a prescription from a physician and mandating a vaccination protocol that must be created with a physician or a state public health official. Some states also limit the types of vaccines pharmacies can administer.

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“Having to comply with the overly-restrictive regulations promulgated by these states imposes excessive costs on pharmacies, and may even effectively eliminate the convenience, efficiency, and education services the pharmacies can offer patients,” wrote the Pacific Research Institute. “In either scenario, the benefits from expanded access are lost due to these overly-restrictive policy environments.” Pharmacies also lack the data access to effectively increase vaccination administration, the report stated.

For example, a case study in Washington showed that when pharmacists gained access to patient vaccination histories, they were able to identify unmet vaccination needs for their patients. The number of vaccines administered also grew 41.1 percent over a six-month period.

Additionally, reporting requirements challenge the shift of vaccine administration to pharmacies.

“The variation in how to report immunization information to the states, and the varying consent requirements pharmacists must obtain from patients, have been noted by pharmacists as major challenges that require a substantial amount of staff time that frequently understaffed pharmacies do not have,” the report stated.

Pharmacies may also have to invest in new technologies to comply with reporting requirements that mandate organizations submit certain types of files, such as HL7. Pharmacists in a 2014 survey reported that the costs of adhering to reporting requirements led to underutilization of vaccine administration.

To overcome these barriers and reduce the costs of vaccine administration, Pacific Research Institute advised healthcare stakeholders to promote and implement policies that “grant pharmacists the authority to independently screen, assess, and administer all CDC recommended adult vaccines without a protocol or a prescription from a physician on a national basis, while holding pharmacists to the same accountability and reporting requirements as other providers.”

Stakeholders should also develop standard reporting requirements and give pharmacists access to patient vaccination histories, the group advised.

“Reforms such as these will reduce the unnecessary regulatory costs imposed on pharmacists and increase the choices patients have with respect to vaccination services,” the report concluded. “Empowering pharmacists to administer vaccines also serves as an important case study for the broader health care system. Increasing access across the health care system can provide patients with more choices, increase overall health care quality, and effectively ‘bend the healthcare cost curve.’”