The decline in immunization rates is especially concerning for people with low incomes who Medicaid covers, as they are far less likely to get their flu shots than people with Medicare or private health insurance. Moreover, racial and ethnic minorities, who are overrepresented in Medicaid, face additional barriers to accessing preventive health-care services, exacerbating the disparities in immunization rates.
While immunization rates may have dipped in recent years for all demographics, there are things we can do to strengthen our system for getting vaccines into the arms of people who need them most. We should start with pharmacists.
In 2023, researchers from the IQVIA Institute for Human Data Science and the Global Healthy Living Foundation demonstrated that an overwhelming number of adult patients in the U.S. receive their vaccinations at pharmacies. The research led to state efforts to expand and enhance pharmacists' authority to immunize, similar to the authority enjoyed by their physician peers.
This year, the same organizations investigated one of the root causes of low immunization rates, specifically among Medicaid fee-for-service (FFS) patients. The researchers examined whether there is a correlation between reimbursement rates and vaccine uptake in the Medicaid FFS population. As things stand, low payment rates under Medicaid to pharmacies in many states barely cover the cost of the vaccine, shortchanging patients and providers alike and reducing access to quality care. The paper concluded that there is indeed a positive statistical relationship reimbursement and adult vaccination rates among Medicaid FFS patients. The primary finding is that a mere $13 increase in total Medicaid reimbursement for pharmacies was associated with an increase of 6 percentage points in a state’s flu vaccination rate.
Pharmacists are America’s most accessible health-care professionals. About 90 percent of the population lives within five miles of a pharmacy; for most people, the pharmacy is the most accessible place to get vaccinated. In low-income communities, there tend to be significantly more pharmacies than physician practices, and the pharmacies offer more convenient hours. Pharmacists’ presence in the community makes them approachable and trusted: Year after year, polling shows that pharmacists rank among the country's most trusted professions.
During the pandemic, pharmacies played a huge role in delivering COVID-19 vaccines, thanks to the Public Readiness and Emergency Preparedness (PREP) Act, which allows pharmacists and pharmacy technicians to administer COVID-19 and flu vaccines without a prescriber order. The PREP Act and other modifications made during the pandemic significantly increase pharmacy vaccine administration, according to the IQVIA researchers.
However, the PREP Act will lapse at the end of the year in states where its expanded authority has not been made permanent by new state laws. As many as 40 states have expanded vaccination authority for pharmacists and pharmacy technicians. However, many of them still have laws on the books restricting pharmacists’ ability to administer certain vaccines to specific populations, and those laws will once again take effect when the PREP Act expires. Without action, there will be a patchwork of state laws, and easy access to life-saving vaccines will depend on where a patient lives.
With pharmacies playing a growing and crucial role in immunization efforts, it is time to ensure that state policies adequately compensate them for providing vaccines to Medicaid beneficiaries. We recommend that states review Medicaid reimbursement to ensure that rates are at least at the Medicare level. At the same time, we must advance state laws mirroring the PREP Act so that pharmacists, pharmacy interns and pharmacy technicians can administer flu and all other recommended vaccines.
Ensuring that pharmacists and pharmacy technicians in all states can administer vaccines will increase immunization rates, reduce health-care costs and save lives. It will also lay the groundwork for an improved, more robust and more equitable health-care system.
Anita Patel, who holds a doctorate in pharmacy, is the vice president of pharmacy services at Walgreens. Robert Popovian is the chief science policy officer at the Global Healthy Living Foundation. Vibhu Tewary is the project director at the IQVIA Institute for Human Data Science.
Governing’s opinion columns reflect the views of their authors and not necessarily those of Governing’s editors or management.
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