Pharmacists in Texas want to be able to keep vaccinating the way they have been during the pandemic, but physicians are not supportive of any permanent changes to what has historically been best practice.
In 2020, Public Readiness and Emergency Preparedness Act gave U.S. pharmacists and certified pharmacy techs the ability to vaccinate children aged 3 and above in light of the COVID-19 pandemic, expanding their capabilities. Before the act, pharmacists could only administer vaccinations to those aged 14 and up. The PREP Act is set to expire in October, and pharmacy advocates are moving to make the change permanent in Texas. But not everyone is on board.
In the 2023 legislative session, Texas panhandle state representative Four Price introduced HB 1105 to make the authority given to pharmacists and pharmacy techs permanent in the Lone Star State. Several states have already passed similar laws since the Prep Act made it possible. Only 13 states have more restrictive influenza vaccine prohibitions than Texas. For the COVID-19 vaccine, pharmacists could give vaccines to those 14 and up if the PREP Act expires. Only 10 states are more restrictive for the COVID-19 vaccine. Pharmacy technicians are not able to provide vaccines at all under state law.
Expanding one’s scope of practice is nothing new in healthcare. In addition to past legislation pushing for these changes in 2021, some physicians want to be able to distribute medication as well. Texas is one of five states that doesn’t allow physicians to provide medicine for a limited range of conditions, which advocates say would improve cost and compliance. Some physician advocates want to take on the responsibilities of what is currently the job of a pharmacy, and vice versa.
Pharmacy advocacy groups like the Texas Pharmacy Association will argue that making these responsibilities permanent improves access and takes the pressure off physicians who are already overworked and burnt out. Since the pandemic, pharmacies have transformed their patient flow, online booking systems, and staffed up to respond to the need brought about by COVID-19. The majority of COVID-19 vaccines and boosters have been administered in a pharmacy. Their location and availability have made them an attractive option for immunization.
According to a report from the IQVIA Institute for Human Data Science, 90 percent of the country lives within five miles of a community pharmacy. The equivalent of the entire U.S. population will walk through a community pharmacy every week. During flu season, 60-70 percent of flu vaccines occur in a pharmacy. During the pandemic, the PREP Act has allowed pharmacies to play a more prominent role in getting children caught up on missed immunizations alongside their work combatting COVID-19. With a couple of years’ worth of data showing that pharmacies can safely administer expanded vaccine responsibilities, pharmacy advocates hope 2023 will be their year.
“Consumers have come to expect that access at their pharmacy,” says Debbie Garza, the CEO of the Texas Pharmacy Association. “We’re advocating to let the pharmacists continue to be access points based on what people choose to do.”
A nearly identical bill passed the Texas House in the 2021 session but failed to pass the Senate. This sort of legislation has not been without opponents. One of the Texas Pediatric Society’s 2023 legislative agenda is to “Defend best practice immunization policies that have kept our communities safe for decades.” Frisco pediatrician Dr. Seth Kaplan submitted a letter to the Texas House Public Health Committee arguing against the 2021 version of the same bill.
“The best practice provision of health care for children is provided within a medical home with a physician team lead so each of the child’s unique health needs can be addressed in a holistic approach. Fragmenting their care via one-off visits at a pharmacy can leave children vulnerable to missed screenings, diagnoses, and care otherwise not caught by the child’s primary care physician,” Kaplan wrote.
On behalf of the Texas Pediatric Society, Kaplan argued that a physician could already order a vaccination in a pharmacy if needed. As children get older, they are less likely to seek preventative care, and immunizations often keep students connected to a medical home where they can comprehensively evaluate the child’s health. “This legislation
would erode the medical home and jeopardize the quality of care that children receive.”
Physicians, Kaplan argues, have the clinical knowledge to better explain the risks of not getting a vaccination. Getting them back on track can be more complicated for children who have missed vaccinations, and pediatricians are “uniquely qualified to understand the complexity of their patients’ needs,” Kaplan writes. The COVID-19 vaccine complicates matters further regarding the immunization schedule, and “the coordination and communication required to make sure child and parents understand the appropriate spacing of routine vaccine, is most appropriate for the child’s medical home.” Finally, Kaplan argues that the current system works well, with more than 96 percent of 7th graders receiving their adolescent vaccinations in the 2019-2020 school year.
But Garza argues that fewer children have a medical home than ever, and while having regular contact with a primary care physician is best practice for adults and children, the convenience and accessibility of the neighborhood pharmacy mean that passing this bill would mean more kids will end up immunized. The Kaiser Family Foundation found that only 42.7 percent of Texas children had a medical home in 2021, 46th in the nation. “We will help get those kids caught up and push people into that medical home visit,” she says. “Pharmacists don’t fragment care; they complement it and add to it.”
Rural communities that already suffer from a shortage of providers can benefit as well, Garza says. Physicians in those communities are already swamped, and Garza says they often prefer vaccines to happen at the pharmacy for simplicity’s sake. In many communities, immunizing more widely in a pharmacy is an advantage for pediatricians and pharmacies alike. For those who work long hours and can’t get their children to the pediatrician’s office during the workday, pharmacies also provide another opportunity to be immunized, Garza says.
The next six months will determine whether this bill has more traction than two years ago. Garza expects a companion bill to be filed in the Senate any day now. The proof, she says, is in the pudding of the last two years under the PREP Act. “Clearly, there’s been no issues or problems with having pharmacists being able to do this. Why not continue and allow that access point?”