This article originally appeared in Chain Drug Review, August 7, 2017
By Robert Dudzinski
Retail pharmacies need to maximize the full value of a key revenue stream: immunizations. While most pharmacy chains offer flu shots, the continued development of vaccines along with their expanded indications will be an important driver of revenue, customer loyalty and health outcomes. It will also improve the persona of pharmacy as an important provider of health care services to their customers.
After all, an estimated 40,000 to 50,000 of American adults die annually of vaccine-preventable diseases. Meanwhile, vaccinations that target a number of niche markets — such as the HPV vaccine for teens and the shingles vaccine for patients over 50 — are heavily advertised and widely recommended by primary care physicians. So there is a significant need for increased vaccination and plenty of available vaccines to meet these needs. However, vaccination rates for adults in the U.S., for instance, remain low — well below the projected Healthy People 2020 targets.
Vaccinations in nontraditional settings
To bridge this gap, the health care community must increase convenient access to vaccinations throughout a patient’s lifespan. Pharmacists can play an important role in this public health imperative, while simultaneously boosting their bottom lines.
With 93% of Americans living within five miles of a pharmacy, community pharmacists are one of the most readily accessible health care professionals in the U.S. Pharmacists serve as a source for patient education, medical convenience, health advocacy and product safety. In addition, through these nontraditional settings, pharmacists make an overall high contribution to public health despite the inherent challenges of vaccination programs. This results in a positive impact on the delivery and output of vaccination services that ultimately benefits the community. For example, during the 2011/2012 influenza season, approximately 20% of U.S. adults received their influenza vaccinations from a supermarket or drug store, which represents an increase from around 18% during the 2010/2011 season.
Other studies have explored patient preferences for receiving vaccinations in a pharmacy or from another non-physician in a nontraditional setting. Unlike other medical settings, community pharmacies address many factors that are important to patients, including convenience, the ability to visit multiple locations, extended hours and reduced costs for vaccinations.
Considering the current role of the pharmacist as a health care provider, the case can be made for pharmacies to move away from strictly distributing product to administering direct patient care. In fact, pharmacies have a unique opportunity to serve as agents of change by evolving the current business model to focus on more meaningful interactions with those in their communities.
It is also important to consider the market opportunity linked to vaccination programs. The global vaccines market is expected to reach $48.03 billion by 2021 from $32.24 billion in 2016 at a compound annual growth rate of 8.3%. At the point of delivery, immunizations are a frontline therapy for many physician offices and create revenue from the visit and product. For example, a 20% vaccination rate drives a 6% increase in front-end revenue, in addition to the revenue generated from the vaccination itself. Considering these metrics, a pivot in the business model for pharmacies can lead to increased market share and higher sources of revenue.
From a process standpoint, pharmacies are uniquely positioned to engage with patients to manage vaccination schedules and encourage the administration of vaccines. This is especially true as it relates to the management of series immunizations, a process that typically suffers from adherence issues. However, there are challenges that need to be addressed for pharmacists to be successful in the long term. Some notable examples include variances in immunization practices across states, inconsistent reimbursement mechanisms for immunizations and technology challenges.
Need for integration
If pharmacies are to continue to play a role in the delivery of public health programs, it is crucial to continue advocating for legislative change that redefines the role of pharmacies as providers of patient care. In addition, technological advancements would greatly benefit community pharmacies. Current pharmacy technology is capable of handling orderready and refill reminders and, in some cases, appointment scheduling. Expanding these efforts to focus on vaccination is a natural extension.
Pharmacies can integrate vaccine education and compliance programs into existing patient outreach, using a combination of automation and the pharmacist touch. All patients over the age of 50, for instance, could receive a text message, voicemail or email — according to their preference — educating them on their risk of contracting shingles and detailing the availability of the vaccine at the pharmacy. Pharmacists could follow up personally with a subset of patients with comorbidities that would make the shingles virus more dangerous, or with patients known to be noncompliant with other treatments. This type of pharmacy care pathway could also include communications back to primary care or other physicians to “close the loop” and provide true care coordination.
Such an approach would help to address the challenges of current communication practices across the care continuum. For instance, when patient record systems are managed independently between primary care physicians and pharmacies, this creates inconsistencies in communication and the inability to access patient records for vaccination data. By integrating these systems, pharmacies can lead by offering the capability to administer patient education, immunization tracking, reminders and reimbursements for vaccines services — all in one place. The result is a robust system that can adequately track patient vaccinations over the long term, and ultimately position community pharmacies as the primary source for immunization delivery.
Robert Dudzinski, Pharm.D., is executive vice president at West Corp. He has extensive experience in pharmacy benefits management, mail order pharmacy, home care, management information systems and related industries, spanning a 30-year period, and he leads the health care practice at West. He can be contacted at rdudzinski@ west.com.