Vaccinating Missouri

In 2007, legislation was passed to allow Missouri pharmacists, for the first time, to dispense vaccinations to their patients.

By CHRISTIAN S. TADRUS, Pharm.D. | Treasurer | MPA

If we are truly to call ourselves health care professionals, we need be focused on health.  For a pharmacist, that primarily means the injection of our pharmacologic knowledgebase into the plan of care for the patient either at the dispensing level or in a growing number of cases, through close collaboration with other health care professionals and the patients they serve.  Not that we can’t offer other services and products in our environments but the core of what a pharmacist needs to be known and relied upon for should be centered on health and health-related services.

One of the services pharmacists can offer to its clientele is immunizations. Pharmacists in all 50 states can now vaccinate. Missouri was somewhat late as an addition to the national list granting pharmacists the ability to offer such services having only been granted legislative authority to do so in 2007.

Training isn’t hard to acquire. The American Pharmacist Association (APhA) offers the most widely available certificate program at many association meetings around the country – including MPA’s own Annual Convention.  In addition, both schools of pharmacy in Missouri offer or require immunization training for their students prior to graduation.

Giving vaccinations isn’t hard to do. Dispensing pharmacists are masters of efficiencies – we have to be with the workload we’re expected to address during a typical day.  For most, a vaccination has become “just another script” in terms of processing. Streamlined processes involving intake, data entry and processing, verification, administration and follow up documentation have evolved in the busy pharmacy environment to allow patients to complete the entire process – from walk-in to injection in around 20 minutes including a Missouri Board of Pharmacy requirement to wait 15 minutes after injection for observation).

Administration is considered a different act from dispensing. In Missouri, a prescription is an authorization for a pharmacist to dispense a properly labeled product to a patient.  This allows for dispensing of a vaccine as well but in order to actually administer that prescription, a pharmacist must have authorization from physician or prescriber to do so (and have proper board-approved training).

The Board of Pharmacy has published a wealth of information on its website to help pharmacists understand the qualifications, procedures, record-keeping and notification requirements for immunizing pharmacists. A checklist is available that cuts through the legalese of the regulations and serves as a quick reference for a immunizing pharmacist or employer.

Many pharmacists are reluctant to get started, those with just a few injections under their belts lack confidence to give injections, or perhaps those not yet comfortable integrating injection directly into existing workflow don’t have to go big right out of the gate. Strategies to help gain confidence and the experience needed to ramp up to a more significant practice include options such as offering vaccinations only to your staff and family for the first year, offering less frequently-requested vaccines such as zoster or pneumonia for the first few months or simply offering vaccinations by scheduled appointment only when workload is less stressful.

In fact, appointment-based vaccination services offer additional benefits that can be used to the pharmacists’ advantage. Grouping like vaccinations can reduce errors due to confusion that may arise from switching between vaccines, needle sizes and routes of administration between patients.  Families can come in together to help alleviate fear related to receiving an injection.  And scheduled appointments can be a good solution for attracting larger groups of patients needing special accommodations for vaccination services.

Developing a solid vaccination service will take time and effort. Just having the vaccine in the refrigerator or freezer won’t make the sales happen.  It typically takes significant marketing efforts, word of mouth and some good old fashioned door-to-door salesmanship to generate significant movement in this category.

Get out and market your services! High value targets should include your own patients – especially those with chronic health diseases such as diabetes, asthma or heart failure. Our own patients are easy to reach through personal daily contact, bag-tags, direct mail or traditional advertising avenues such as radio, tv and newspaper. Physicians and other prescribers can become excellent partners and referral sources as well. Employer groups, small businesses, chambers of commerce offices, nursing home administrators, home health agencies, senior centers and church groups also represent potential clients.

Pharmacists typically experience resistance from prescribers when made aware of a pharmacist’s immunization offerings due to a lack of understanding regarding a pharmacist’s qualifications, territorial concerns and frustration due to competitive pressure. The immunizing pharmacist should make efforts to reassure providers that these services are meant to help meet the patient care goals of the provider and are not meant to supplant or replace them.  Low reimbursement and workload are not only burdens of the pharmacy world, and prescribers will often see the benefit of utilizing a competent and caring pharmacist to help improve the bottom line.

The self-insured employer group is a good space to start marketing when you’re ready to go big.  Many self-insured employers are large enough to have someone that is responsible for controlling their health care costs. In some cases this will be a nurse or a human resource manager and in other cases might be the vice president or even CEO.  Pharmacists should use their existing contacts to try to identify the person with authority to make those decisions and set up an appointment. Personal conversations with decision makers are typically how growth happens for an organization or provider. Such meetings also open the doors to additional service offerings such as Medication Therapy Management.

Pharmacists should be prepared to discuss with corporate decision makers the benefits of offering immunizations – especially flu shots – to their employees.

A power point or other document can help you clearly lay out the rationale for immunizations and the benefit of providing them.

The Immunization Action Coalition ( has one of the largest and most complete collections of resources available on the web. A visit to the site will reveal the myriad of talking points and clinical resources available to the immunizer. ϖ

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