The Reality
Adult immunization rates are low; they have always been low but does that mean we should just accept it? In addition, community pharmacy profits are shrinking during a time when this is a significant pocket of need. Communities are vaccine wary and vaccine trust is low. We see this as an inflection in time where in a year we hope to say adult immunizations are rising, community pharmacy profit is growing, and communities are regaining momentum to protect the most at-risk through immunizations. But this will not occur if Public Health and Community Pharmacy Immunization Programs continue to operate independently or in silos. STChealth has developed a collaborative value-added partnership model so patients, pharmacists, and public health all win; without breaking the bank or overburdening staff.
STChealth implemented a secure technical infrastructure and operates a national immunization data exchange that connects community pharmacies to state immunization information systems (IIS). Data from over 57,000 pharmacies report their patient immunization events to their state IIS. These events are consolidated to create a comprehensive patient record that captures their digital immunization history. This information is then made available to patients and health care providers, including pharmacists. This robust infrastructure includes integrated reporting from community pharmacy to an IIS, as well as the inclusion of decision support tools that forecast a patient’s immunization gaps, resulting in an environment that can turn technology and handling of data into revenue, lower risks to vaccine preventable disease to at-risk populations, and increased consumer trust.
The Opportunity
A public-private immunization partnership is the best operational model that can leverage the established technology infrastructure that exists today. This is the subject of another article. First it is important to demonstrate the potential value to a community pharmacy if they choose to expand their current immunization efforts. We have selected two examples to illustrate the revenue/profit potential impact.
Immunization events reported since January 1st of 2024, indicates 6.7 million new patient immunizations have been given by the network of subscribed pharmacies. Just using this total number and not identifying the specific vaccines, we can do a quick back of the napkin calculation of the total revenue dollars for these pharmacies. We choose to use an average of $70 per immunization to account for healthy growth in the administration of flu and non-flu immunizations. If each new patient received one additional vaccination, this equates to $469M in revenue. If this was shared equally by the 57,000 pharmacies reporting to the STC network, $8,200 in new revenue could have been received by each pharmacy in the first 2 ½ months of the year. This can be considered as the baseline as there is significantly more untapped opportunity that surfaces by working closely with public health and leveraging the information contained in these consolidated patient records.
For example, in this same time frame through the network, these pharmacies made over 38.8 million patient queries to retrieve immunization histories from the respective IIS. These are electronic real-time requests that provide not only the patient record but also forecast the missing immunizations they are recommended to have. This knowledge creates the opportunity to educate and offer additional immunizations as patients arrive at the pharmacy for their service. Past studies in partnership with APhA demonstrated that there would be a 41% uptake in additional immunizations if the pharmacist and patient reviewed what was needed when a patient arrived in the pharmacy for a single flu shot1.
The napkin calculations indicate that with a potential 41% increase, an additional 2.7M new immunizations could be provided. This could generate another $189 million in revenue or another $3,300 in revenue for each pharmacy. Over the course of the year a conservative estimate of $48,000 in new revenue per location is not out of the question. All using what exists today and by simply having the right conversations, especially when coordinated with local public health messaging. Easy money. Well, not quite, as the true value to an individual location would be directly related to the level of effort each pharmacist chooses to allocate to their immunization program. But we believe it would only go up.
A second example is more to the point using immunization outcomes established from STChealth’s Project Protect, a Healthy People 2030 adult immunization initiative. This program targets Adults between the ages of 19-64. This community continues to have low vaccination rates for all recommended vaccines. Healthy People 2030 defines adult vaccination as a high-priority public health issue and are seeking pharmacy partners to overcome the low numbers. As such, Project Protect is an operational initiative between pharmacies in a state and their state public health department. The public health goal is to increase the adult immunization rates through targeted joint campaigns. Utilizing reported events to measure the effectiveness of these efforts. This program is an all-win initiative.
Looking at the revenue upside for the pharmacy, we selected data points from one state IIS for five adult immunizations commonly provided by the pharmacist: Flu, COVID, RSV, Pneumonia and Zoster. In 2023, a total of 5.1M of these immunizations were provided. Of this number we selected a sample of 1000 pharmacies to estimate revenue considering both missed opportunity and potential opportunity from the age-appropriate population. From this sample it was determined that and additional 1.77M adult immunizations could have been provided. Each of these 5 adult vaccines have their own revenue profile but for sake of consistency using the $70, the 1.77M additional vaccines would generate $123.9M in revenue. For the 1000 sample it generates $123,000 in revenue per pharmacy per year.
Next Steps
Since the technical environment exists and is fully operational 24/7, the opportunity exists for the community pharmacists to play a more important role in reducing the impact of vaccine preventable disease on populations. By partnering with public health and creating a proactive immunization program, a community pharmacist added revenue per location is only limited by the level of effort they invest to inform their patients of their risks to disease. More immunizations are giving, adult immunizations increase, public health regains momentum, patients and communities risk profiles are reduced. Store revenue increases, and patient service levels are strengthened. Whether it’s another $48,000 or $123,000 per year in revenue or for that matter 2 -3 times these numbers, it is simply a matter of using what community pharmacists already have in place, expanding their immunization patient education and establishing a strong communication channel to their local public health agencies.
If your pharmacy is not providing immunizations, it should be considered. If you do, ensure you have an electronic connection between your PMS and the State IIS that allows for two way data exchange. Once this is in place take every opportunity when a patient requests a specific immunization to also access the state IIS and determine what other vaccines they should consider. Have the appropriate conversation, encourage, and offer expertise that increases the uptake and reduced their risk. If you really want to be proactive use this same infrastructure to generate reminder notices to your community of patients. If you partner with local public health, they will use their education and technical resources to create community wide campaigns that help bring traffic into your pharmacy.
1 https://www.liebertpub.com/doi/pdfplus/10.1089/pop.2017.0049
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