Putting the president’s pharmacy vaccine plan into action

This week, President Joe Biden made an encouraging announcement: He’s directing state governors to make COVID-19 vaccines available to every adult by April 19, about two weeks earlier than previously planned. Details of the president’s plan, first proposed about a month ago, include more than doubling the number of pharmacies participating in a federal pharmacy program to more than 20,000 nationwide. In other words, if you have not gotten your vaccine shot yet, it may soon be coming to a pharmacy near you.

However, to further advance what appears to be a winning strategy, it makes sense to tailor state and federal rules so that pharmacies can accomplish as much good as possible.

Biden’s plan makes a lot of sense. His administration has learned some crucial lessons in recent weeks. One is that simply increasing the number of facilities offering vaccines does not necessarily translate into shots being put into arms. Evidence from 21 mass vaccination sites set up across the country has so far been underwhelming. According to a recent report in Politico, these sites have only been averaging about 67,000 shots a day, compared to almost a million as part of the federal retail pharmacy program. Not surprisingly, the administration is doubling down on its pharmacy strategy as a result, which also makes sense given the relative costliness of the mass vaccination sites.

Yet there is more that can be done to improve the workings of the pharmacy program. One option is to expand the number of trained pharmacy staff allowed to perform vaccinations. Pharmacy technicians are support staff who work at community pharmacies, hospitals, and ambulatory care centers, among other pharmacy settings. They perform a variety of tasks including filling prescriptions, assisting with inventory, and performing insurance and billing operations. They can also take on more advanced roles, such as conducting point-of-care tests, compounding medications, and vaccinating.

Even before the pandemic, state governments were recognizing the untapped resource that pharmacy technicians represent. In 2017, Idaho became the first state to allow them to administer vaccines under the supervision of an immunizing pharmacist. The Trump administration followed suit and issued nationwide guidance in 2020, which remains in place, allowing qualified pharmacy technicians to administer COVID-19 vaccines.

However, many states set limitations on how many of these trained support staff can work in a pharmacy at any given time, for example through “ratio requirements” that dictate how many technicians can be supervised by one pharmacist. This constrains immunization capacity.

At first glance, these restrictions seem like they make sense. We do not want pharmacists overwhelmed by managing an excessive number of employees. However, not all requirements stand up to further examination. Other medical professionals, such as physicians, are usually not limited in terms of how many nurses or medical assistants they can oversee. Rather, we tend to trust their professional judgment on such matters.

Similarly, many states have no ratio requirements at all, and this has not led to any obvious problems with safety or quality of care. According to a new study of ours, as of 2020, there were 22 states without a ratio requirement, which is up from 18 in 2016. During the pandemic, at least eight states have relaxed or removed their ratio requirements altogether as part of their emergency response.

The most recent example comes from Montana, where Gov. Greg Gianforte recently issued an emergency declaration allowing qualified pharmacy personnel to administer vaccines. He also waived the state’s pharmacy technician ratio requirement.

This trend is likely to continue and even accelerate as the vaccination effort continues to ramp up. When the supply of vaccines is no longer the binding constraint, creating an environment where patients feel comfortable and safe could be the primary impediment to achieving herd immunity. Pharmacies have an obvious advantage in this area, since so many people visit them routinely. Moreover, new versions of the vaccine are likely to be approved soon that do not have the same storage needs as current versions, which has limited the role pharmacies can play to-date.

Ratio requirements and other restrictions on pharmacy personnel limit the operational capability of pharmacies. Even some seemingly reasonable restrictions constrain the quantity of health care services at a time when we need them most. With a possible fourth wave of COVID-19 on the horizon, health care professionals are in a race against time. It’s time to take the shackles off their feet so they can run.

James Broughel is a senior research fellow and Yuliya Yatsyshina is a program manager with the Mercatus Center at George Mason University. They are coauthors of a new study, “Pharmacy Technician Ratio Requirements.”