Shooting from the ‘Scrip: Scope of Practice Laws and Access to Immunizations in the Pharmacy Setting

Background: In the past 17 years most states have added some form of authorization for pharmacists to administer some vaccinations.  Expansions of this authority have also come with prescription requirements or other regulatory burdens.

Methods:  I evaluated the impact of the expansions in pharmacist’s authorization on influenza immunization rates.  I combined a novel dataset of state-level statute and regulation changes with influenza immunization data from the Behavioral Risk Factor Surveillance System.  I used a panel data, differences-in-differences regression framework to control for state-level unobserved confounders and shocks at the national level.

Results:  I found giving pharmacists permission to vaccinate had a positive impact on adult influenza immunization rates of approximately 0.5%.  This effect was diminished by the presence of laws requiring pharmacists to obtain standing orders, patient-specific prescriptions, or malpractice insurance.  The effect on immunization was larger when pharmacists were allowed to prescribe vaccinations under their own authority.  The increased immunization coverage rates were concentrated in insured populations.

Conclusions:  Expanding pharmacist’s scope of practice laws to include administering influenza vaccine had positive impacts on overall health.  Access to other vaccines in this nontraditional setting could have further benefits particularly those with lagging benefit effects such as HPV.