Pharmacist Provided Medication Administration
Adult immunizations provided by pharmacists, the most accessible healthcare professionals, is an issue
whose time has arrived. Pharmacists trained and certified to provide immunizations will serve a twofold
purpose. First, more at risk patients will be vaccinated and second, the base of medical professionals that
can provide immunizations in case of a public health emergency will be expanded.
To provide a brief history, in 1999 a group made up of pharmacists from academia, hospital practice, and
both chain and independent retail pharmacy; formed the Rhode Island Institute of Pharmaceutical Care
(RIIPC). The purpose of this group was to advance pharmacy practice in the state.
In the 2000 Rhode Island legislative session, RIIPC, along with the RIPA and the RI Department of Health
proposed a legislative bill that would address three areas. These were to a.) Rewrite the Pharmacy Practice Act, b.)
Provide for Collaborative Practice, and c.) Provide for Pharmacists to Administer Adult Immunizations.
Early into the 2000 session, in meeting with legislative leaders and the RI Medical Society, we were
advised that any bill containing all three agenda items would be defeated. It was determined that the
Pharmacy Practice Act was the most important component and efforts were directed towards its passage.
The RI Pharmacy Practice was passed that year, which resulted in the first major rewrite of the act in nearly
one hundred years.
In the 2001 legislative session, we initially 'floated' the idea of a bill containing the two remaining pieces
of our legislative quest. The RI Medical Society said it would not support both ideas to go forward. It was
decided that a Collaborative Care bill was urgently needed, since this type of practice was occurring, but
without any regulation.
The coalition, including representatives from the RI Society of Health Systems
Pharmacists, worked to calm the fears of the Medical Society and the Nursing Association, as well as to
educate representatives and senators of the need for this bill. The Collaborative Practice bill was passed
into law and allowed pharmacists to enter relationships with physicians to benefit patient care. Regulations
to define Collaborative Practice have been promulgated.
This past spring, the name of the bill to allow pharmacists to administer adult immunizations was changed to a
more politically correct name of Medication Administration. This bill was once more submitted, and again
its passage was blocked. It is now time to start our campaign for the 2003 legislative session, to work
towards the passage of this bill.
Why do we need adult immunizations by pharmacists? An estimated $10 billion is spent annually to treat
adults with vaccine preventable illnesses. In excess of 30,000 people die each year nationally from
Pneumococcal Disease and Influenza. These two diseases are the sixth leading cause of all deaths in the
United States, and fifth leading cause in the elderly.
It is estimated by Medicare (CMS) that in 1999, only 50% of the elderly were vaccinated for Influenza,
and only 41% for Pneumonia. Of the Rhode Island African American population, only 33.3% were immunized for flu.*
By having trained pharmacists augmenting the immunizations already provided by physicians, physicians'
assistants and nurses, it is hoped that a much higher percentage of the population can be protected.
Properly trained and certified pharmacists in other states are currently administering adult immunizations
for Tetanus & Diphtheria, Influenza, Pneumonia, Measles, Mumps, Rubella, Hepatitis, Poliovirus, as well
as vaccinations for foreign travel, such as Typhoid, rabies and Meningitis. Pharmacists will be able to
service patients at job sites, senior centers, retirement homes, as well as their individual practice sites.
Currently, pharmacists in thirty-three states are allowed to administer medication, and get reimbursed for it.
The RI Department of Health, Ocean State Adult Immunization Coalition, URI College of Pharmacy, and
RI Quality Partners are in support of RI pharmacists providing adult immunizations. We will work to
develop a coalition with these groups to develop meaningful legislation. The RIPA will soon be contacting
the RI Medical Society, RI State Nursing Association and the Visiting Nurses Association to gain their
support.
Trained and certified to administer medications, pharmacists can help to address one of the state's biggest
needs and ultimately improve the health of all the citizens in Rhode Island.
*Data provided by APhA from CMS/Medicare
by Roy A. Eckloff , Jr.
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