Utilizing Community-Based Pharmacies to Improve Vaccination Rates in Patients With IBD

Abstract

Introduction: Patients with Inflammatory Bowel Disease (IBD) are at increased risk for vaccine-preventable diseases (Farraye FA, et al. Am J Gastroenterol. 2017 Feb;112(2):241-258). Gastroenterology and internal medicine practices often do not offer vaccinations in their offices. Administration of vaccinations to IBD patients at local community-based pharmacies may offer a cost-effective option. Our aim was to determine the cost, benefits, and other barriers to vaccinating adult IBD patients at their local pharmacy. Methods: We conducted a review of the largest pharmacies in the US using 2015-2016 annual fiscal reports based on prescription revenues and number of stores. Mail-order pharmacies were excluded. We contacted each company to collect data on availability of vaccination for Influenza, Hepatitis A, Hepatitis B, combined Hepatitis A and B, Prevnar (PCV13), Pneumococcal (PPSV23), and Zoster. We assessed for cost variations across the country, discount availability, pharmacy operating hours, and how pharmacies document vaccine administration. Results: We identified seven pharmacies that account for >90% total prescription revenues that oversee between 433-9105 stores. The costs for a single vaccine are comparable between pharmacies (Table 1). Retail costs appear constant across the nation, but actual cost to the patient varies based on insurance provider and plan. The cost variation is notable between vaccines; the most expensive vaccine is Zoster (mean $246, range $224-$273), and the least expensive is Influenza (mean $19.50, range $14.99-39.99. The health plan and employer determine the actual cost to the patient.Table: Table. Cost in Dollars for Self-Pay Patients and Pharmacy Operating HoursConclusion: Vaccination rates for IBD patients are low, in part related to lack of vaccine availability in gastroenterology and internal medicine practices. Thus, alternative methods to conveniently administer vaccines are needed. Referring IBD patients to local community-based pharmacies bypasses the challenges of determining whether IBD patients should receive their vaccines at gastroenterology or primary care offices. This uncertainty often delays successful and timely vaccination. Benefits also include convenient patient access on a walk-in basis and the assurance that larger chains are typically fully stocked with inventory. Pharmacies process vaccination charges like a prescription, and patients receive the bill in the mail. Further research examining the affordability of community based pharmacy vaccination versus administration in an office based setting is ongoing.