Strategy
New York City allows independent pharmacies to enroll in a non-patient specific (standing) order program so that pharmacists can administer vaccines. The standing order program is focused on independent pharmacies that do not have access to a standing order (e.g., no medical director or no partnership with a community physician) and allows them to administer all vaccines that pharmacists are authorized to administer to patients 18 years of age and older, as well as influenza vaccine to patients 4 years of age and older.
Challenge
Pharmacies were given authorization to vaccinate in 2009. While chain pharmacies participated, there was initially little engagement from independent pharmacies as many did not have access to a standing order. Independent pharmacies tend to be more accessible for those in areas with higher rates of poverty.
Solution
NYC modeled their standing order program after their Vaccines for Children (VFC) program. Independent pharmacists sign a cooperative agreement with requirements to:
- Report aggregate doses administered to the Bureau of Immunization
- Report individual doses administered to the Citywide Immunization Registry (with patient consent for persons 19 years and older)
- Participate in a compliance site visit during the first year of enrollment and periodically thereafter
- Be listed on the NYC Health Map, which lists vaccination services based on type and insurance status
- Participate in a citywide vaccination campaign in the event of a pandemic
The standing order allows pharmacists to administer hepatitis A, hepatitis B, HPV, MMR, meningococcal, pneumococcal, RSV, tetanus-containing, varicella, and zoster vaccines to patients 18 years and older and flu vaccine to patients 4 years of age and older.
Outcome
For the 2023-2024 program year, 334 pharmacies were enrolled in the standing order program, with locations in all five NYC boroughs (counties). Overall, these pharmacies administered 81,114 vaccines from September 1, 2023, through August 31, 2024.
Independent pharmacies also played a key role in ensuring access to COVID-19 vaccination services during the pandemic. Although more individuals received their first COVID-19 dose from a chain pharmacy, several high-priority populations had increased odds of being vaccinated at an independent versus a chain pharmacy in comparison to the reference groups, including those ages 65 years and over, non-Hispanic Asian people, Hispanic people, and people living in neighborhoods with higher poverty levels.
Supplemental Materials