Implementation of a Pharmacy-Based Adult Vaccine Benefit: Recommendations for a Commercial Health Plan Benefit

Abstract

BACKGROUND: Although vaccination rates in children exceed 90% in the United States, adults are vaccinated at far lower rates. In order to address this issue, additional community immunizers are needed, and pharmacists are in an ideal position to fill this void.

Community pharmacies as sites of adult vaccination: A systematic review

“…PBIS represent a financially feasible alternative to traditional immunization sites; however, efforts should be made to address the existing billing and reimbursement barriers to mitigate lost opportunities to provide vaccinations. There has been little research into optimal financing mechanisms and billing procedures; 79 our results indicate that streamlining PBIS billing and reimbursement could improve feasibility.…”

“…18,60,79 While these regulations help to maintain complete and accurate patient records, they may unintentionally lead to "missed opportunities" to vaccinate. Moreover, the additional demands placed on pharmacists and their staff to complete these requirements may ultimately pose a barrier for pharmacy involvement in immunization services.…”

“…43 Planning and implementation should occur at multiple levels by preparing individual personnel, adapting PBIS to the specific pharmacy site, and addressing organizational and attitudinal barriers. 57,79 Lastly, interventions to increase effectiveness can leverage the potential financial benefits of PBIS. PBIS represent a financially feasible alternative to traditional immunization sites; however, efforts should be made to address the existing billing and reimbursement barriers to mitigate lost opportunities to provide vaccinations.…”

“…14,79 The ACA instituted measures to increase access and funding for preventative health services including mandated insurance coverage of ACIP-recommended vaccinations when delivered by in-network providers. 80,81 However, pharmacies are still largely considered outof-network providers and the ACA did not change the terms of Medicare Part D coverage, which create additional challenges for both patients and pharmacists pursuing insurance coverage and reimbursement.…”

Interventions to Improve Adolescent Vaccination

“…115,120 Multiple barriers have been identified, including reimbursement for vaccination and tracking of provided vaccines. 115,121,122 However, given the proven success of pharmacists as vaccinators of adults, finding ways to implement a similar approach for adolescent vaccination may be a fruitful area for future study. Educational interventions directed at parents and adolescents may not be hugely effective.…”