CKAPhA OCPIP SNU4 Community Pharmacy- based Immunization & SB493 Jung Yun, Park Bo Eun, Choi

Contents 01. Journey to pharmacist-provided vaccination in the USA 02. Current state 03. Role of the pharmacist in immunizations 3.1 Pharmacists as vaccine educators 3.2 Pharmacists as vaccine facilitators 3.3 Pharmacists as immunizers 04. State-based pharmacist immunization laws 05. SB Challenges

Journey to pharmacist-provided vaccination in the USA Pharmacy involvement with vaccines and immunization in the USA has been noted since the mid-1800s but was limited in function, with pharmacies serving as a source of storage, preparation, distribution, and education, and as hosts of immunization providers in their practice. DHHS officially recognize APhA, so pharmacists are able to play an integral role in vaccine education, mobilization, distribution, access, record keeping, administration, and, ultimately, improving vaccination rates. The first organized immunization training program for pharmacist- administered immunizations took place in Seattle, Washington, in late APhA partners with 3 organizations to develop a model immunization program for teaching pharmacists to immunize. More than 40,000 pharmacists and student pharmacists are taught to immunize through the APhA Pharmacy- based Immunization Delivery : A National Certificate Program for Pharmacists. California pharmacists achieve provider status and independent immunization practice in 2013 under Senate Bill 493.

Current state 93% of Americans live within 5 miles of a community pha rmacy. In 2011–2012, 20.1% of US adults received their influenza vaccinations from a supermarket or drug store – an increase from 18.4% during the 2010–2011 season. In 2013, 86% of community pharmacies in the U.S. provide adult immunizations.

Role of the pharmacist in immunizations EDUCATOREDUCATOR FACILITAT OR IMMUNIZE R

Pharmacists as vaccine educators Pharmacists act to educate and recommend to the patients the importance of and need for receiving v accinations. Pharmacist-provided patient vaccine education, scr eening, and recommendations have been shown to increase vaccination rates The pharmacist’s role as a vaccine educator enhan ces patient adherence to vaccinations through initia ting an open discussion, providing education, and p atient follow-up with the pharmacist.

Pharmacists as vaccine facilitators As vaccine distributors, pharmacies facilitate other pr oviders in administering vaccinations by ordering and distributing vaccine products to physicians and medic al clinics. According to the research, about one in five pharmaci es engaged in vaccines distribution by reselling or dis tributing vaccines to local physicians and/or clinic. The pharmacist’s role as a facilitator improves immun ization rates by increasing other health care providers ’ accessibility to vaccine products and the locations w here these providers can offer immunization services.

Pharmacists as immunizers As active immunizers, pharmacists assess patients for indications and contraindications and administer vaccines directly to the patients that they serve. Community pharmacy-based immunization service s are a cost-effective, convenient, and accessible al ternative for the public to receive vaccinations. With increased accessibility, pharmacists have help ed to improve immunization rates, bring patients up -to-date on vaccinations, and reach those who may not otherwise have an opportunity to be vaccinated.

State-based pharmacist immunization laws All 50 states in the U.S. including Washington DC a nd Puerto Rico, allow pharmacists to administer va ccinations. Amongst states, laws vary: –Need for a protocol and/or prescription –Minimum age limit –Type of vaccines

California Law – Prior to (11) Administer immunizations pursuant to a protocol with a prescriber

California Law – As of January 1, 2014 (SB 493) (a) In addition to the authority provided in para graph (11) of subdivision (a) of Section 4052, a pharm acist may independently initiate and administer vaccin es listed on the routine immunization schedules recom mended by the federal Advisory Committee on Immuni zation Practices (ACIP), in compliance with individual ACIP vaccine recommendations, and published by the federal Centers for Disease Control and Prevention (C DC) for persons three years of age and older.

SB 493: Immunization Requirements (4052.8) In order to initiate and administer an immunization described in subdivision (a), a pharmacist shall do all of the following: (1) Complete an immunization training program endorsed by the CDC or the Accreditation Council for Pharmacy Education that, at a minimum, includes hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines, and shall maintain that training. (2) Be certified in basic life support. (3) Comply with all state and federal recordkeeping and reporting requirements, including providing documentation to the patient’s primary care provider and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.

SB493 Declares pharmacists as healthcare providers who have the authority to provide health care services. Authorizes all licensed pharmacists to: Administer drugs and biologics when ordered by a prescriber. Pr eviously, this was limited to oral and topical administration. SB 4 93 allows pharmacists to administer drugs via other methods, in cluding by injection. Provide consultation, training, and education about drug therapy, disease management and disease prevention. Participate in multidisciplinary review of patient progress, includi ng appropriate access to medical records.

Furnish self-administered hormonal contraceptives (the pill, the patch, and the ring) pursuant to a statewide protocol. This authority is similar to the existing e mergency contraception protocol. Once a statewide protocol is adopted by the Board of Pharmacy, it will automatically apply to all pharmacists. Furnish travel medications recommended by the CDC not requiring a diagnos is. Furnish prescription nicotine replacement products for smoking cessation pur suant to a statewide protocol if certain training, certification, recordkeeping, an d notification requirements are met. Once a statewide protocol is adopted by th e Board of Pharmacy, it will automatically apply to all pharmacists. Independently initiate and administer immunizations to patients three years of age and older if certain training, certification, recordkeeping, and reporting requ irements are met. A physician protocol is still required to administer immunizati ons on children younger than three years of age. Order and interpret tests for the purpose of monitoring and managing the effic acy and toxicity of drug therapies, in coordination with the patient’s primary car e provider or diagnosing prescriber. SB493(continued)

Current challenges Reimbursement Lack of shared patient record systems

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