The Role of Pharmacy in Vax Program Innovation

You, being a modern, health-conscious person, undoubtedly have someone you can refer to as “my doctor.”  Odds are, you have a list:  my primary, my dermatologist, my allergist and so on. But, what about “my pharmacist”? Less likely? And here’s a thought: would we all be better off if we had one?

That question was on my mind because I recently got to interview John Beckner. If you know John, I’m betting that just seeing his name in print made you smile. He’s like that. And because he recently retired from most of his roles at the National Community Pharmacy Association (NCPA), I was glad to have an excuse to seek his opinions and reflections, especially about leadership in vaccination programs.

JOHN BECKNER, PHARMACIST

First, how does a boy growing up in Chilhowie, a town in rural Virginia, become a pharmacist? That wasn’t John’s plan: no, as a young man he wanted to be a dentist. But then, influenced by an uncle who was an Abbot Labs rep, he took a summer job at one of the town’s two pharmacies. John explained what happened next: “I saw what that the pharmacist did, and the relationships that he had with his patients and the hometown doctors. That made quite an impression on me, and I decided that this might be something I’d like to do. So, I applied to a couple of pharmacy schools and ultimately decided to attend the Medical College of Virginia (MCV), now VCU.”

And… spoiler alert… right there we first see the theme of John’s career and his influence on the profession: pharmacy as relationship building.

PHARMACY AND VAX

After working for MCV and for a national chain, John ended up working for a small, family-owned chain of pharmacies that was bought by a national chain; then he was hired by another family business, and that was one of his most formatives experience: “I ran the pharmacies for a couple of small chains in Virginia. One of them was Ukrop’s Super Markets, one of the most innovative grocers in the country. When I came on board, they had four pharmacies. That grew to 25 or 26. The owners were two brothers, James and Bobby Ukrop, and it was one of the best experiences that I have had in pharmacy. When they hired me, they wanted the same type of innovation on the pharmacy side as they had been able to implement on the grocery side; so, they pretty much gave me free rein. When pharmacists began to be authorized to do immunizations in the mid-to-late 90s, I shared with the Ukrop brothers that we need to be in this business, and they encouraged me to ‘go for it.’ They trusted me that this was the right thing to do, and we ended up being one of the first pharmacy chains in the country to immunize. I think we also may have been the first chain or first pharmacy to offer travel vaccines. I was very fortunate work for Bobby and James Ukrop — I cannot say enough good things about them. Outside of encouraging innovation and entrepreneurship, they operated their company based on the Golden Rule: they expected associates to treat customers like they wanted to be treated.”

John added, “I want to give credit where credit is due: It wasn’t just me. Shane Kraus, the physician who signed our protocol, and Kelly Goode from the VCU School of Pharmacy, who provided clinical oversight and direction, were both instrumental to our success.”

Speaking of the Golden Rule, John later told us the story of how he managed to overcome the reluctance of many medical practices to welcome pharmacies into the vaccination business.

“It was still viewed as a turf issue,” John explained. “For a lot of physicians, immunizations were an important revenue stream. I remember one year there was a vaccine shortage — one of the manufacturing companies for flu vaccine had a problem with one of their facilities in England, and they had to shut down. That adversely impacted the supply of vaccine in the marketplace. We had ordered from a couple of different companies — we didn’t put all our eggs in one basket, thank goodness — so we did get about half of our supply. We then made a strategic decision: rather than keeping it all to ourselves, we elected to share a portion of our supply with the physicians in town. We made a lot of friends, and I think that really helped us down the road in terms of gaining greater acceptance of pharmacies and immunizations.”

THE FUTURE OF PHARMACY

What about the fact that the number of community pharmacies has been steadily declining? I asked John if there is reason to be optimistic about their future, and he told us this:

“There are 19,000 independent community pharmacies. We’re losing at least one a day and I think it may be more bordering on two a day. That’s going to continue to happen until we can we can get a rein on the PBMs [pharmacy benefit managers]. Reform is happening too slowly. While we’re waiting on laws and regulations to be put in place, we’re still losing a lot of community pharmacies. That’s just the reality. But there also is reason for optimism. COVID shined a very bright light on the capabilities of not only pharmacists but pharmacy teams, because of all that the technicians contributed. That raised the antenna of the public as well as other providers. We need to continue to collaborate with other providers because it’s much better to have somebody outside the profession advocate for you. When you look at primary care and the continued shortage, there is a great role for pharmacists to step in and play.”

John added this advice for those expanding their services: “Whether it’s vaccines or other clinical types of services, one of the things that that has to change is — and I think it is changing — moving from a focus on product to a focus on service.”

Specifically, John encourages pharmacies to move aggressively into vax programs and then this: “I think diabetes is still an area where pharmacists can really make a difference, especially when it comes to helping patients with education. I’ve got a personal connection: my wife and one of our children has Type 1 diabetes. We’ve been very involved with used to be the Juvenile Diabetes Research Foundation and is now Breakthrough T1D. Diabetes always will have a special place in my heart, and it’s a huge opportunity for pharmacists to make a difference.”

RETIRED (ALMOST)

Speaking of making a difference, John Beckner frequently has been recognized for his contribution to his profession, and now, after 48 years, he has stepped down… or not quite all the way down. He explains: “I officially retired from NCPA at the end of last year. I decided to stay on board in a consulting capacity, and right now my main responsibility is that I continue to host our podcast called Independent RX Forum. It’s a joy, doing that. The topics run the gamut from advocacy to mental health to immunization. Early in my career, I hosted a live call-in television program called Appetite for Health and it was a medical program. My guests were often physicians, sometimes other pharmacists, but we picked up medical topics. If you can believe this, I was on longer than Bonanza. We were on for 17 years.  So, my interest in a podcast-type vehicle goes back to my television days.”

SUMMING UP: IT’S ALL ABOUT RELATIONSHIPS

As emphasized along the way, John Beckner’s career has been devoted to relationship building, and that extends to his advice for pharmacies wanting to grow their relevance in health care. It’s fitting that vaccination programs would foster a relationship-building model as most vaccinations offer a rare chance to build rapport; after all, in most cases, you sit down together, with emphasis on “together.” That’s the chance to not just give a shot, but to take a shot at making a difference in that person’s health.

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STATS OF THE MONTH

Time to Reset the Shot Clock?

By Bill Davenhall, Geomedicine Analyst

For those that follow basketball, you are probably familiar with the “shot clock,” the timer that gives you precious minuets to either shoot the ball and at least hit the rim or give the ball to the opposing team. Got that clock in your mind’s eye? (Major league baseball has some new “pitch clocks” that deliver the same type of urgency.)

Well, now think of immunizations. With the advent of digital technologies and the likelihood that everyone who could get immunized has some form of a shot clock opportunity. Even the newborn can have an immunization shot-clock if their parents own a smart phone —which is a very high probability. (The vast majority of Americans – 98% – now own a cellphone of some kind. About nine-in-ten (91%) own a smartphone, up from just 35% in the Center’s first survey of smartphone ownership conducted in 2011. If that is not convincing enough, read up on the numerononics of cell phones across various segments of the population here.)

So, what’s the excuse of the immunization community? There are no restrictions on a healthcare provider communicating directly with anyone that they serve – unless, of course, the patient intentionally opts-out — if it’s about an issue, concern, or reminder of a possible intervention, like an immunization.

Focusing on households is often a smarter way to look at outreach reminders. A pharmacy with an existing patient relationship can reach the large majority of households through treatment communications permitted under HIPAA and here is why — very few households have zero pharmacy interaction in a given year (especially if there’s a child in the household). More information can be found here as it relates to the possible scope of the various age segments of the US population.

As a health-seeking senior, I would appreciate more immunization reminders about the need for an any immunization appropriate for me; and, better yet,  a profile of my immunizations without making me work so hard to keep up with My Immunization Records as I move to various geographical regions of the US. Medicare has this after age 65, but what about immunization that occur before your enrollment in Medicare?

Is this a serious application of consumer borderless immunization Ai?

As always, I appreciate your 2^nd opinions,