New protocol includes broad coverage, increased access

Consumers can now get most major vaccinations at the pharmacy without a prescription, thanks to the new protocol for administration of vaccines by pharmacists recently approved by the South Carolina Board of Medical Examiners.

The protocol, recommended by an inter-professional committee representing pharmacists, physicians, nurses, nurse practitioners and the South Carolina Department of Health and Environmental Control (DHEC), was adopted November 4, 2015.

“It means adults will be able to get almost any vaccine without a prescription, which is a huge win for South Carolina patients,” said Brandon Bookstaver, a University of South Carolina (USC) pharmacy faculty member who served on the inter-professional committee and is a member of the South Carolina Immunization Coalition. “We’ve seen how increased access for the flu vaccine was a boost for people’s health. This expansion will dramatically increase our ability to prevent the cost and suffering of disease.”

The new protocol covers vaccines for flu, pneumonia, shingles, human papillomavirus or HPV (which can lead to cervical cancer), and a half dozen more diseases. Children under 18 will still need a prescription for the vaccines, though children 12 or older can get the flu vaccine without a prescription.

The increased access is good news to Megan Draper, whose parents were in need of a vaccine for pertussis (whooping cough) earlier this year so they could hold their new granddaughter.

“My parents had to get the vaccine for the whooping cough and they didn’t really want to go to the doctor’s just for that,” said Draper, who lives in Charleston, S.C. “They tried the pharmacy but the vaccine required a prescription. A lot of people are going to be very happy having it available in the pharmacy.”

Draper’s physician recommended all the baby’s caretakers have the vaccine, given that South Carolina pertussis cases increased from 26 cases in 1999 to nearly 400 in 2010 and there were more than 100 in 2012 and 2013, according to DHEC. Pertussis is included in the new protocol.

HealthyPeople2020, the nation’s 10-year goals and objectives for health promotion and disease prevention, has immunization goals for a number of disease states including 70 percent for flu and 90 percent for pneumonia. South Carolina’s respective numbers of 53.9 percent and 47.2 percent should receive a needed boost from the increased access. Governor Nikki Haley cited those numbers when issuing a Governor’s Proclamation about vaccinations earlier this year.

With the adoption of this protocol, South Carolina joins a growing trend of states with broad prescription-free immunization authority for pharmacists. According to the American Pharmacists Association, as of August 2015 South Carolina was one of 17 states still requiring prescriptions for non-influenza vaccines while 31 had adopted broader protocols. More than a quarter of a million pharmacists have been trained in APhA’s Pharmacy-Based Immunization Delivery Certificate Program in the last 20 years and the Centers of Disease Control and Prevention recently issued a letter commending pharmacists for the profession’s contribution to reducing vaccine-preventable diseases.    

Earlier this year, South Carolina passed the scripts immunization expansion bill (S. 413) changing pharmacy practice law to expand vaccine availability pending the recommendations of the interprofessional committee to the board of medical examiners, which adopted the proposal with minor revisions.  The committee was composed of two physicians, two advanced practice nurses, two pharmacists and a member of DHEC.

Patti Fabel is past president and chairman of the board of the South Carolina Pharmacy Association (SCPhA), which was one of the organizations advocating for the adoption of the scripts immunization expansion bill.

“This protocol gives teeth to the bill so that it can have the significant impact on people’s health that we believed in when we were pushing for it,” said Fabel, who is an assistant professor of clinical pharmacy and outcomes sciences on the USC campus of the South Carolina College of Pharmacy (SCCP).  

The cost of immunization to the consumer depends on their health insurance and the type of vaccine. The pharmacies themselves will decide which vaccines they will carry, although broad availability is expected.  

Terry Blackmon owns The Medicine Cabinet in Lake City, S.C. He plans to start offering various vaccines based on the demand he sees for them, and believes some patients may benefit from vaccines they didn’t realize they needed before becoming engaged in a conversation with the pharmacist.

An immediate impact of the new protocol is it allows trained student pharmacists to administer vaccines under the supervision of a pharmacist, which will have a significant impact on the large flu vaccine traffic The Medicine Cabinet already gets. In addition, it will help cement their knowledge with practice, since most student pharmacists are trained on immunizations in college.

“Before, the interns might get trained during pharmacy school and then go several years before being able to actually give a vaccination,” said Blackmon, who is actively involved at the Medical University of South Carolina (MUSC) where he went to school. “That’s a big lag time for them to lose their comfort level with administration.”

At the USC and MUSC campuses of the SCCP, students receive immunization training and certification at the beginning of the third year of the four-year program.

The pharmacy immunization expansion bill was sponsored by Sens. Cleary, Hugh Leatherman (R-Florence), Kevin Bryant (R-Anderson), Kevin Johnson (D-Clarendon), Paul Campbell (R-Berkeley), Harvey Peeler, Jr. (R-Cherokee), Michael Fair (R-Greenville), and Katrina Frye Shealy (R-Lexington).

Pharmacists were first authorized to provide flu vaccinations without a prescription in 2010, when the South Carolina General Assembly passed Act 224, the first legislation passed in South Carolina directly addressing pharmacist-administered immunizations.