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The Dose

Trailblazing Pharmacist Immunizer Reflects on Changes, Opportunities for Community Pharmacies

by Kevin Schweers | Jan 21, 2016

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An early pioneer in pharmacist-administered vaccinations is Brandon Cooper, PharmD, the staff pharmacist at Soo's Drug & Compounding Center and Co-owner of Soo's West End Pharmacy, both located in Jonesboro, Ark. We profiled him and two other community pharmacists with active immunization practices in the August issue of America's Pharmacist. Recently we checked back to ask what's new and to solicit advice for other community pharmacies interested in expanding into this field.

Below is our discussion, part of NCPA's effort to highlight Diversified Revenue Opportunities for community pharmacies grappling with declining prescription drug reimbursement.

NCPA: How is the current influenza immunization season going so far? Have you experienced any supply issues? What has been the interest this year given the fact that the influenza vaccine was only marginally effective last year?

Cooper: We continue to see high demand for immunizations and vaccinations as word continues to spread around our community of the service we provide. Our travel vaccine volume continued to increase over the past summer, and now we receive referrals from the health department and local physician groups, churches, schools, and those who have utilized our services in the past.

We have not experienced any supply issues this year and overall have utilized almost our entire supply of flu vaccines we ordered for the current season. Our patient base continues to receive flu vaccines, although some have commented that they "hope this one is better than last year" at curtailing flu outbreaks. So far, we have continued to see increased demand for flu vaccines this year and anticipate needing even larger supplies next year.

NCPA: Do you offer all types of influenza vaccine? How did you decide how much of each to order?

Cooper: We increased the supply of regular and high-dose flu vaccines this year as compared to last year, and also kept a few doses of the quadrivalent vaccine as well. We based most of the ordering on what we gave last year combined with some flu clinics that we had lined up with local employer and insurance groups.

NCPA: Are flu shots mandatory for your employees?

Cooper: No, but highly encouraged.

NCPA: What do you (or would you) say to a fellow independent community pharmacist who does not offer immunizations in their pharmacy?

Cooper: As margins continue to shrink due to decreased PBM reimbursements, vaccines are a good way to increase your business & profitability. It also helps add value to your patient base and can be a great tool to increase business in other areas as well as providing exposure to local physicians and businesses on other services that pharmacies can provide.

NCPA: What resistance or biggest problems did you encounter when starting (or expanding) your practice? And how did you overcome those? Do you offer offsite immunizations to employer groups? Have you partnered with any physician groups?

Cooper: Simply finding the time and staffing to deal with a new service was a challenge, but business picked up rather quickly once word of mouth spread. It is also a good idea to involve all staff members from an early stage in helping to channel in prospective patients and to help with the logistics of starting an immunization practice. The past few years we have partnered with local employers and insurance groups to offer off-site flu clinics. This year we anticipated doing even more clinics which helped us plan for the correct inventory and staffing to be provided.

We continue to receive pushback from a small number of local clinics or providers who feel that we are encroaching on their territory and have scolded patients for having vaccines given to them at a pharmacy. One such patient had an allergic reaction to a pneumonia vaccine. After returning to our pharmacy we quickly gave her recommendations for over-the-counter treatment and advised her to see a physician for prescription treatment if her condition worsened. The physician she saw at a local clinic provided her with erroneous information about not requiring an additional dose of the new pneumonia vaccine and scolded her for entrusting the pharmacist to give her a vaccine that she should have sought out from their own medical practice. This situation really proved to us that there is still a need to educate the medical community regarding pharmacist administered immunization services.

NCPA: In some areas the national chain pharmacies and supermarkets heavily market their flu shot offerings. Is that true where you live? What marketing strategies do you employ to compete with the national chains?

Cooper: Local chains and supermarkets continue to increase their immunization offerings, but we still find that most people prefer our location and decreased wait times as compared with other pharmacies in the area. It was also helpful that we were one of the first pharmacies in the area to start offering immunizations, thus allowing us to get our "foot in the door" from an early stage.

NCPA: Have you noticed any change with regard to health insurance plans covering pharmacist-administered immunizations? Can you give a rough approximation of how many do cover it? Do any plans cover immunizations only under the medical benefit? If so, are you able to bill for these?

Cooper: There have been increased numbers of insurance plans that have started covering immunizations through the prescription benefit, although we have also partnered with other insurances that require us to bill through on-line portals and paper billing to the medical insurance. I would estimate that over 75 percent of plans now cover immunizations, including most Part D plans. There are still a few that will only cover the actual product without paying an administration fee.

NCPA: What role do technicians play with respect to your program?

Cooper: They are an integral part in screening prospective patients that need certain immunizations and help to market our services to those we, as pharmacists, may not come into contact with on a daily basis. They also help in having patients fill out the screening paperwork, with insurance coverage problems that may arise, record-keeping, and helping to keep workflow going while the pharmacists consult with patients. We've also found that if technicians and all pharmacy staff "buy-in" on these other pharmacy services it helps increase profitability and patient satisfaction.