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New Mexico Public Schools Insurance Authority
and Catalyst Rx
Pharmacists as Immunization Providers
Problem Identification
New Mexico is a large, rural state. Many residents have difficulty obtaining immunizations because of the lack of traditional providers in their communities. To increase accessibility, New Mexico law allows CPR-certified pharmacists who successfully complete a special 12-hour continuing education program, through the New Mexico Pharmacists Association (NMPhA), to prescribe and administer vaccines. However, an inefficient manual claims process dissuaded many pharmacists from participating. Ensuring that immunizations were being administered only by qualified pharmacists was another challenge.
Objectives
The New Mexico Public Schools Insurance Authority (NMPSIA) and Catalyst Rx sought to increase immunization utilization among NMPSIA members by providing access in local pharmacies and making administration convenient for pharmacists.
Target Audience
Two groups were targeted: NMPSIA members representing 60,000 covered lives and more than 130 New Mexico pharmacists qualified to administer vaccines. In particular, the program targeted rural-community NMPSIA members who could benefit from a host of standard immunizations.
Solution
NMPSIA and Catalyst Rx developed the Pharmacists as Immunization Providers Program, built on multi-faceted outreach to members and qualified pharmacists, and a new online adjudication solution. Through this program, pharmacists certified to administer vaccines provide a host of immunizations in their local pharmacies, including influenza, pneumonia, tetanus/diphtheria, measles/mumps/rubella (MMR), meningitis, hepatitis A and B (child and adult) and diphtheria/pertussis/tetanus DPT. New vaccinations continue to be added to the program as they become available, e.g. GARDASIL® (human papilloma virus) and Zostavax® (herpes zoster/shingles).
Critical success factors include:
· User-friendly, online claims adjudication solution to give pharmacists a convenient way to file for reimbursement.
· A system using unique national provider identifier (NPI) numbers to ensure only state-certified pharmacists administer immunizations.
· Established reimbursement rates agreed to in advance by participating pharmacies.
· Extensive letter and telephone outreach to all New Mexico immunization-certified pharmacists inviting participation.
· Abundant member communications, including local benefit fairs, member newsletters, extensive educational materials and provider directory on the NMPSIA Website. Numerous pharmacies posted window banners and printed flyers at their own expense to advertise the program.
· Zero co-pay for immunizations to incentivize member participation.
Results
Before partnering with Catalyst Rx, NMPSIA implemented a similar program, but it did not include an online adjudication solution or extensive member and pharmacist outreach. Between July 1 and Nov. 30, 2005, only 1,653 NMPSIA members received 3,099 pharmacist-administered immunizations.
Those figures increased dramatically after the collaborative NMPSIA/Catalyst Rx program was implemented in July 2006. Between July 1 and Nov. 30, 2006, NMPSIA experienced a 142%
increase in the number of members who received pharmacist-administered immunizations and a 151% increase in the number of immunizations over what had been achieved during the same time period in 2005.
Year-to-year results continue to be positive as the number of members receiving pharmacist-administered immunizations increases steadily. (See table below.) While the number of members taking advantage of this program increases, the number of immunizations administered year-to-year decreases because many immunizations, such as tetanus and human papillomavirus (HPV), do not need to be repeated every year.
| Time Frame |
No. of Members Receiving Immunizations |
No. of Immunizations |
| July 1, 2006 - June 30, 2007 |
4,601 |
11,153 |
| July 1, 2007 - June 30, 2008 |
5,209 |
9,578 |
| July 1, 2008 - Dec. 15, 2008 |
5,651 |
8,310 |
| Totals: |
15,461 |
29,041 |
In total, certified pharmacists from more than 120 communities have administered approximately 29,000 vaccines to more than 15,400 NMPSIA plan participants since July 1, 2006.
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