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Vaccines point to future of pharmaciesRite Aid among those hoping to do more

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Retail pharmacies are providing a growing share of vaccinations, which pharmacies see as a potential path toward more clinical engagement with customers.

Look no further than Rite Aid Corp., which pointed to its own vaccine program as a positive sign of things to come.

The East Pennsboro Township-based pharmacy chain reported a steady increase in the number of immunizations administered at its locations. The company administered over 3.1 million flu vaccinations in the first three quarters of the company's 2018 fiscal year, up from 2.9 million for the same period in fiscal 2017.

With the growth of its flu shot program, Rite Aid has shown it "can execute companywide on delivering low-cost, high-quality health and wellness services beyond filling prescriptions, which gives us a strong foundation for building additional clinical service offerings going forward," president and COO Kermit Crawford said in an earnings call with shareholders.

Those other offerings could vary from different vaccines to different services altogether, like medication management.

"While we have strong momentum with flu immunization, we have a significant opportunity to further increase adult non-flu immunizations that protect against conditions like shingles, pneumonia and whooping cough," said Crawford.

Crawford also called EnvisionRx - a pharmacy benefit management company acquired by Rite Aid in 2015 for $2 billion - "a growth engine for the entire enterprise."

The end game is expanding Rite Aid from a place you pick up prescriptions to a more varied health care setting.

But the path begins with vaccinations, and not just for Rite Aid. Over 300,000 pharmacists across the United States are trained to administer vaccines, according to the 2016 annual report of the American Pharmacists Association. And while a doctor’s office is still the most common place to receive a flu vaccine, pharmacists now account or 28 percent of all flu immunizations according to a survey by the Centers for Disease Control and Prevention. That’s up from a 25 percent in 2015.

Timothy Kaylor, clinical pharmacy specialist for Giant Foods and Martin's locations in eastern and southeastern Pennsylvania, watched as giving vaccines went from a possibility to a necessity for pharmacists.

"I've been doing it personally since 2009 when I graduated college. I was one of the first classes where they said 'this is something you can do' and within the next five years it was almost mandatory for us as part of our training," said Kaylor

"This is a huge need in our communities, not just for children but for adults. Anything that can help us serve our patients we should be able to do," said Kaylor.

Several pharmacy chains already offer a range of vaccines, but proposed tweaks to Pennsylvania state law could let them offer even more. 

The Pharmacy Act, signed by Gov. Tom Wolf in 2015, allows pharmacists to administer only the flu vaccine to children over the age of 9 and no vaccines to children under the age of 9. Both a Senate bill and a House bill introduced last session would allow pharmacies to give all vaccines to children between the ages of 9 and 18 with parental consent.

Pharmacies can also supply niche vaccines to areas without providers who would carry them. This includes inoculations required to travel to some foreign countries like typhoid and Hepatitis A - both of which are offered at Rite Aid, Walgreens or CVS pharmacies. Giant Food offers a "Travel Health" consult to its patients to help them get the right immunizations before traveling, said Kaylor. 

"We offer consult with a patient before they would travel to a country that might have a need like malaria or that kind of preventative treatment," said Kaylor. 

Allowing pharmacies to provide these kinds of services enables them to serve areas that might otherwise have few or no options, said Patricia Epple, CEO of the Pennsylvania Pharmacists' Association.

"Somewhere out in northwestern Pennsylvania, where it’s hard to find somewhere to go if you are traveling to a country and you need certain vaccines, it’s a nice operational service you’re offering your community," said Epple.

Before Pennsylvania and other states began opening the door to pharmacists, patients relied on workarounds to ensure a licensed physician was administering the shot - even when a pharmacy supplied the dose. 

"Years ago, before pharmacies were able to, [physicians] would send you to the pharmacy to get the shingles vaccine then have you drive back to the doctor to administer it," said Epple.

As Epple noted, Rite Aid is far from alone in seeing opportunity to expand past vaccines and develop deeper relationships with patients as a provider. Other services could include medication synchronization or diabetes self-management education - educating patients on changes to their diet and lifestyle that can help fight off the disease's adverse effects. 

"They also can do comprehensive medication reviews, which are to sit down with a patient and take a holistic look at what they’re taking from maybe various physicians," said Epple.

Early intervention by a pharmacist can help patients understand the medication their taking and help them make more informed decisions.

"Pharmacists find quite a few problems when they start sitting down and talking with patients and try to help them get that best care possible," said Epple.

Pharmacists have several advantages over physicians’ practices when it comes to vaccines, including capabilities to store vaccines longer and replace them when they run out. It’s convenience factors like this pharmacies hope to build upon.

As Epple put it, pharmacists can play a unique role in working with patients to better their care. “I really think, and hope, it’s evolving to where pharmacists are really that right hand arm of the physician to help those patients manage their care when they have to take medications,” said Epple.

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