By: Ruobing Han
A state law that’s been in place for less than six months has improved access to key vaccines for Georgia adults.
The legislation allows pharmacists and nurses to administer vaccines for influenza, pneumococcal disease, shingles and meningitis. This is big news for Georgia pharmacists, who have been administering flu vaccines to all customers since 2009 and other shots to people with individual prescriptions from a doctor.
Now pharmacies enter into a blanket agreement with a local physician, called a vaccine protocol, and can administer any of the four vaccines to walk-in customers.
Individual prescriptions, such as the one Athens resident Michael Posey got from his doctor shortly before the law went into effect, are no longer needed. He’s been seeing the same family practice physician for years, “and when I was approaching sixty he started recommending that I get the vaccine against herpes zoster – the shingles vaccine.”
Posey’s doctor didn’t keep that vaccine in the office, however, and there were some reimbursement issues. “So basically he gave me a prescription, and I eventually got it at a pharmacy,” said Posey, who is a pharmacist himself and an editor.
People with limited access to a doctor stand to gain. Six Georgia counties have no primary care doctors and transportation is an issue for low-income people in rural and urban areas. But 93 percent of Georgia residents live within 5 miles of a community pharmacy.
Insured people like Posey also benefit from the new rule, since not all doctors offer vaccines due to low demand and strict storage requirements. Vaccines can be damaged by too much heat, cold or light exposure – making them ineffective.
“For example, the shingles vaccine has to be kept frozen. It has to be administered within thirty minutes after it comes out of the freezer,” said Andy Ullrich, the pharmacist who owns Hawthorne Drugs, an independent pharmacy that has been operating in Athens since 1977.
Each dose of shingles vaccine is worth about $200, and if it is thawed but not administered within half an hour, it must be discarded.
Many people simply like the convenience of walk-in service at a pharmacy. “If you want to get vaccinations at your physician, you’re going to have to make an appointment,” said Posey. “And physicians have office hours that are Monday to Friday from 8 to 5 kind of hours.”
Pharmacies typically have longer hours, and a national study conducted in 2013 found that more than 30% of adults who got their shots at drugstores came in the evening, on the weekend, or on a holiday when medical practices are closed.
Immunizing customers against preventable diseases is an important part of Ullrich’s routine practice, and posters on the walls of Hawthorne Drugs read, “GET YOUR FLU SHOT HERE.”
“We do market it. We do encourage people to get their flu vaccine,” said Ullrich. After pharmacists began providing flu shots in 2009, “the number of people vaccinated went up considerably.”
In September, a public letter from Anne Schuchat, who is in charge of flu programs for the Centers for Disease Control and Prevention, credited pharmacists with helping reduce the risk of vaccine-preventable diseases over the past twenty years.
In Georgia, however, the legislature twice refused to let pharmacists administer adult vaccinations other than flu shots without a doctor’s orders. The Medical Association of Georgia opposed earlier bills, saying that, “the role of the physical cannot be duplicated by the pharmacist.”
“Undermining the physicians’ authority, that was never the intent of the pharmacist being able to administer vaccines to patients,” said Ullrich.
Every dose of vaccine a pharmacist uses is entered into the Georgia Immunization Registry, an online database. “So any health care professional can access that website and see what type of vaccines this patient has received,” said Ullrich.
Over 260,000 pharmacists, which is the great majority of all pharmacists practicing in the U.S., have been trained to provide immunizations. By 2016, immunization training will be part of the core curriculum for all pharmacy schools, according to the CDC.
Across the U.S., lawmakers are proposing bills that would allow pharmacists to administer more types of vaccines and to younger patients. These include the HPV vaccine, which protects against viruses associated with cervical cancer, and MMR vaccines, which protect against measles, mumps and rubella.
University of North Carolina researchers see a pattern in these “scope of practice” laws, especially regarding HPV vaccine, which pharmacists have broader authority in western states than on the East Coast.
Among 47 states where pharmacists are allowed to administer HPV and MMR vaccines, Georgia is one of the few that still require physicians’ prescriptions to do so.
“Hopefully in the future there will be some other vaccines available that we can give to patients,” said Ullrich.