Managed Care - January 2008 - (Page 14) MEDICATION MANAGEMENT Can pharmacists immunize patients effectively? study published in 2004 in the journal Vaccine compared influenza vaccination rates in states where pharmacists were or were not authorized to administer vaccines. Researchers reviewed data from between 1995, when only nine states allowed pharmacists to do so, and 1999, when the number of states had grown to 30. They found that the states that allowed pharmacists to provide immunizations had significantly more people in all age groups who were immunized against influenza than did states that did not. Among patients 18 to 64, states allowing pharmacist administration of vaccines had a 5 percentage point increase in vaccination rates between 1995 and 1999. And for patients age 65 years and older, influenza vaccination rates were significantly higher in states allowing pharmacist vaccination (10.7 percent, compared with 3.5 percent in other states). A ment measures to increase access to those vaccines and any others covered by Part D, and that could well mean a greater role for pharmacists, says Abby Block, director of the CMS Center for Beneficiary Choices, in a recent public statement. “We recognize the intrinsic linkage that exists between the vaccine and its corresponding administration, since a beneficiary would never purchase a vaccine without the expectation that it would be administered. We also want to discourage Part D plan sponsors from designing service networks that force beneficiaries to pay the full cost of vaccines up front and seek reimbursement later.” of an increase in access issue.” Cigna is doing the same, says spokeswoman Lindsay Shearer. “We are reviewing administrative and contractual options to incorporate this within our benefit plans as an option to our members,” she says. “We also cover vaccinations administered by registered nurses in retail clinics that are part of our network, and which may be located in pharmacies. We do believe that it is important for all members to make sure that any immunization becomes part of the member’s official medical record in their physician’s office.” Efficient record keeping is one reason some physicians have resisted the idea of pharmacists administering vaccines, says a spokesman for the American Medical Association. And opponents fear that the decentralization of immunization administration could erode quality and that people may neglect other health care needs by seeing a pharmacist. But several studies show that pharmacists enhance vaccine delivery. In addition, visiting the pharmacist costs less than going to the doctor, people do it more often, and people trust their pharmacists as providers. The time has come “It is definitely an idea whose time has come,” says Beverly Schaefer, a Seattle pharmacist who recently received a grant from the Community Pharmacists Foundation to promote vaccine administration in pharmacies. “Part D will make a difference, I think, on how health plans approach the issue.” Schaefer says she believes that most physicians would agree that immunization administration in their offices is not cost effective for their practices, especially “at just $20 an immunization. They have to buy the vaccine. There are stock and storage issues, scheduling issues, slow payment from insurers.” She adds that not all pharmacists are eager to provide immunizations. “They are concerned about the recordkeeping, about potential liability. But on balance, many see this as a potentially valuable service line. And we believe that if more pharmacists were administering vaccines, more people would be vaccinated.” MC Adjudication process The problem with adopting the policy throughout the plan is that “most vaccines on the commercial benefit side are considered a medical benefit and not really part of the prescription drug rider, so the claims process is adjudicated through a different system,” says Taylor. “We are in the process of getting pharmacists set up in our medical systems to pay them for these medical expenses if this administration is recognized within their scope of practice by state [pharmacy] regulating boards. It is not really a cost-saving measure, but more 14 MANAGED CARE / JANUARY 2008
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