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Pharmacist FAQs

 

Frequently Asked Questions for Pharmacists on Vaccinations

 

WEDNESDAY, AUGUST 4, 2021

UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES ISSUES PREP ACT DECLARATION AUTHORIZING PHARMACISTS TO ORDER AND ADMINISTER, AND  QUALIFIED PHARMACY TECHNICIANS TO ADMINISTER, SEASONAL INFLUENZA VACCINE TO PERSONS AGED 19 OR OLDER.  On August 2, 2021, the United States Department of Health and Human Services issued a declaration under the federal PREP Act authorizing pharmacists to order and administer, and qualified pharmacy technicians to administer, seasonal influenza vaccines during the COVID-19 public health emergency.  Pharmacists may order and administer, and qualified technicians under pharmacist supervision may administer, seasonal influenza vaccine to persons age 19 and older. See http://www.ncbop.org/PDF/PREPActFluVaccineAug2021.pdf. This authority is in addition to that granted pharmacists and qualified technicians under previous PREP Act declarations.  This authority is also in addition to existing authority for North Carolina pharmacists to administer influenza vaccine to patients age 10 or older by protocol, and patients age 6 or older by prescription.   

For prior PREP Act authorization for qualified pharmacist technician administration (including the requirements for a qualified pharmacy technician), see here:  http://www.ncbop.org/PDF/PREPActTechnicianVaccination102220.pdf.

 

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TUESDAY, DECEMBER 29, 2020

STATE HEALTH DIRECTOR SIGNS STANDING ORDER AUTHORIZING IMMUNIZING PHARMACISTS IN NC TO ADMINISTER COVID-19 VACCINES. North Carolina State Health Director, Dr. Elizabeth Tilson, signed a standing order authorizing immunizing pharmacists in NC to administer the COVID-19 vaccines in order to reduce the morbidity and mortality of COVID-19. This standing order authorizes pharmacists licensed by the North Carolina Board of Pharmacy and practicing in North Carolina to administer FDA-authorized or FDA-licensed COVID-19 vaccines to eligible recipients.  The standing order spells out the eligible recipients, proper procedure, and reporting requirements: http://www.ncbop.org/pdf/COVID19StatewideStandingImmunizingPharmacists12_27_20signed.pdf.

Immunizing pharmacists must meet the qualifications listed in N.C.G.S. 90-85.3:
-completion of an immunization certification course
-current provider-level CPR
-immunization specific continuing education
-training on how to participate in the North Carolina Immunization Registry

Additional information:

This statewide standing order is state law, and it is an authorization for pharmacists to administer the COVID-19 vaccines in addition to the Federal DHHS’ Declarations under the PREP ACT authorizing administration of COVID-19 vaccines by pharmacists, pharmacy technicians, and pharmacy student interns. http://www.ncbop.org/PDF/PREPActTechnicianVaccination102220.pdf.

 


 

 

MONDAY, OCTOBER 7, 2019 - NEW VACCINE ADMINISTRATION AUTHORITY

*UPDATE* GENERAL ASSEMBLY PASSES, AND GOVERNOR COOPER SIGNS INTO LAW, NEW VACCINE ADMINISTRATION AUTHORITY FOR PHARMACISTS. On June 3, 2019, Governor Cooper signed into law S.L. 2019-21, which will increase pharmacists’ authority to administer vaccines. Here’s what you need to know:

1. Will pharmacists be able to administer more vaccines to patients 18 and older pursuant to protocol? Yes. This legislation adds Serogroup B meningococcal vaccines, human papillomavirus vaccine, and Hepatitis A vaccine to the list of vaccines that a pharmacist may administer to persons 18 or older pursuant to protocol.

2. Will pharmacists be able to administer flu vaccine by protocol to younger patients? Yes. This legislation authorizes pharmacists to administer flu vaccine to patients at least ten (10) years old pursuant to protocol. Pharmacists are authorized to administer flu vaccine to patients at least six (6) years old pursuant to a prescription order.

3. Is this new authority effective now? Yes. The legislation became effective on October 1, 2019.

4. What resources does the Board recommend for pharmacists?

First, the North Carolina Academy of Family Physicians, the North Carolina Medical Society, the North Carolina Pediatric Society, the North Carolina Association of Community Pharmacists, the North Carolina Association of Pharmacists, and the North Carolina Retail Merchants Association have produced (as required in the statute) a new minimum standard screening questionnaire for immunizing pharmacists. You can download the revised questionnaire here.

Second, Board staff recommends that immunizing pharmacists collaborate with their supervising physicians to revise their vaccination protocols to reflect the new vaccines that may be administered and the new permissible age for flu vaccine administration.

5. I’d like to read the new legislation. Where can I get it?

Session Law 2019-21 / House Bill  833 (2019 revisions to NCGS 90-85.15B Immunizing Pharmacists Administration Authority) http://www.ncbop.org/PDF/NCGAVaccineAdministrationAuthorityPharmacists0719SL2019-21HB388.pdf

Session Law  2013-246 / House Bill 832 (2013 with new subsections NCGS  90-85.3 (il) Definition of an immunizing pharmacist and all required qualifications and NCGS 90-85.3A Practice of Pharmacy and revisions to NCGS 130A-153 Obtaining immunizations; reporting by local health departments; access to immunization information in patient records; immunization of minors)  https://www.ncleg.net/Sessions/2013/Bills/House/PDF/H832v6.pdf

 


 

Q: How do the immunizing pharmacist provisions of the Pharmacy Practice Act impact the dispensing of oral typhoid vaccine (marketed as Vivotif)?

A: Several pharmacists have contacted Board staff with questions about how, if at all, the immunizing pharmacist provisions of the Pharmacy Practice Act impact the dispensing of oral typhoid vaccine (marketed as Vivotif).  The short answer is that, for all practical purposes, they do not.  Recall that the immunizing pharmacist provisions of the Pharmacy Practice Act speak to whether and under what circumstances a pharmacist may administer a vaccine to a patient.  The dispensing of oral typhoid vaccine, which a patient self-administers just as any other oral medication, is not limited those provisions governing vaccine administration.  The most frequent question concerning oral typhoid vaccine is along the following lines:  “I have a prescription for oral typhoid vaccine for a 16-year-old patient.  But the immunizing pharmacist provision limit administration of vaccines other than those allowed by protocol to patients 18 or older.  May I nonetheless dispense the oral typhoid vaccine to this patient?”  Again, the answer is yes.  Limitations on vaccine administration do not prohibit the dispensing of this self-administered oral vaccine to a patient, regardless of age, pursuant to a valid prescription. 

 

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Q: Where can I find more information about using the NC Vaccination / Immunization Registry?

A: The NC Department of Health and Human Services has information and training for the NC Immunization Registry available at https://immunize.nc.gov/providers/immunizingpharmacists.htm.

 

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Q: Are pharmacists required to report influenza vaccine administration to the North Carolina Immunization Registry?

A: No. NCGS 90-85.15B(d)(3) (part of the pharmacist vaccine administration statute passed in 2013) previously stated that “except for influenza vaccines administered under G.S. 90-85.15B(b)(6)”, an immunizing pharmacists must “access the North Carolina Immunization Registry prior to administering the vaccine . . . and record any vaccine . . . administered to the patient in the registry within 72 hours after the administration.”  The clear intent of the statute, therefore, was that influenza vaccine administrations not be reported to the Registry.  Confusion rose because the referenced paragraph – G.S. 90-85.15B(b)(6) – does not exist.  Rather, influenza vaccine administration is discussed in G.S. 90-85.15B(c).  The mismatched cross-reference has now been corrected by the General Assembly, and the statute is now clear that influenza vaccines administered under G.S. 90-85.15B(c) do not have to be reported to the Registry.

 

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** JULY 1, 2014 UPDATE ** GENERAL ASSEMBLY GRANTS PHARMACISTS BROADER VACCINATION AUTHORITY. On July 3, 2013 the Governor signed S.L. 2013-246, An Act to Protect the Public’s Health by Increasing Access to Immunizations and Vaccines through the Expanded Role of Immunizing Pharmacists.  The text of the statute may be found here, and pharmacists are strongly encouraged to read the new statute:  http://www.ncleg.net/Sessions/2013/Bills/House/PDF/H832v6.pdf  Pharmacists are, understandably, asking a number of questions about implementation.  The following are the most common ones:

1. When does the law take effect?  The law’s effective date is October 1, 2013.    Pharmacists may begin exercising this broader authority after October 1 provided that all requirements of the statute and rule are met.  Protocols must be updated – including incorporation of the mandatory minimum questionnaires (see #5 below).  Immunization registry training must be completed and access activated (see #4 below).  Information must be available to provide to patients who do not indicate a primary care provider (see #8 below).

2. What does the law allow?  “Immunizing pharmacists” who meet the requirements in the statute may administer any CDC-recommended vaccination to any patient at least 18 years of age pursuant to a specific prescription order.  Immunizing pharmacists may administer pneumococcal, zoster, hepatitis B, meningococcal, tetanus, tentanus-diptheria, and TDAP vaccines to patients at least 18 years of age pursuant to written protocols as defined in existing vaccination rules (found at 21 NCAC 46.2507).  Pharmacists may continue to administer the influenza vaccine to patients age 14 and over as specified in current rules.

3. What notifications will be required?  The immunizing pharmacist must notify the patient’s identified primary care provider within 72 hours of administering any vaccine.  If the patient does not identify a primary care provider, the pharmacist will be required to “direct the patient to information describing the benefits to a patient of having a primary care provider,” which information may be prepared by any of the North Carolina Medical Board, North Carolina Academy of Family Physicians, North Carolina Medical Society, or Community Care of North Carolina.  As these organizations develop these materials, Board staff will endeavor to provide links to them.  Except for flu vaccines, a pharmacists must, within 72 hours, report administration of any vaccine to the North Carolina Immunization Registry, if “operable.” 

4. How do I get access to the North Carolina Immunization Registry?  Various stakeholders are working with Immunization Branch officials on training and access issues.  Registry access training has begun.  Roll-out is gradual.  Some pharmacists have completed training and have obtained access to the registry.  Others have not.  Provided that a pharmacist has met all of the other requirements of the new statute, he/she may begin exercising the new immunization authority upon obtaining access to the registry. 

5. I’m already an immunizing pharmacist.  Should I begin revising my supervising physician protocols?  Board staff recommends that immunizing pharmacists discuss the expanded authority with their supervising physicians and preparing appropriate changes to protocols.  Those agreements must specifically include the “minimum standard screening questionnaire and safety procedures” for protocol-administered vaccines (i.e., non-prescription based vaccines).  That questionnaire, which was agreed upon by the North Carolina Academy of Family Physicians, North Carolina Medical Society, North Carolina Pediatric Society, North Carolina Association of Community Pharmacists, North Carolina Association of Pharmacists, and North Carolina Retail Merchants Association is found here: http://www.ncbop.org/PDF/ImmunizingPharmacistsMinScreeningQuestionnaire091313.pdf. The Pharmacy, Nursing, and Medicals has received and accepted the questionnaire.  If immunizing pharmacists have updated their supervising physician agreements in accordance with the new law, they may begin administering prescription-based CDC-recommended vaccines to adult patients or the specifically listed protocol-based vaccines to adults (or patients 14 and up for flu) when access to the immunization registry becomes available (see question # 4 above). 

6.  How do I register with the Board of Pharmacy and Board of Medicine as an immunizing pharmacist?  North Carolina pharmacists who provide immunizations are already documented in the Board of Pharmacy database.  Pharmacists will continue to confirm immunizing pharmacists status each year as part of  the license renewal process.  Pharmacists do not need to separately notify the Medical Board of their immunizing status.  The Board of Pharmacy will, upon request, provide the Medical Board with any information it may need. 

7.  Where may I obtain “information describing the benefits to a patient of having a primary care physician” that the statute directs me to provide to a patient who “does not identify a primary care provider”?   The statute says that, when administering a protocol-based immunization to a patient who does not identify a primary care provider, the immunizing pharmacist shall “direct the patient to information describing the benefits to a patient of having a primary care physician prepared by any of the following:  North Carolina Medical Board, North Carolina Academy of Family Physicians, North Carolina Medical Society, or Community Care of North Carolina.”  The North Carolina Academy of Family physicians has prepared an information sheet, which may be downloaded here: http://www.ncbop.org/PDF/WhatIsAPrimaryCarePhysician.pdf.  Board staff will post any like materials prepared by the Medical Board, Medical Society, or CCNC.

Please continue to monitor this website for further updates on this important issue.

 



WEDNESDAY, JUNE 29, 2011

Governor Perdue Signs S609, Which Authorizes Pharmacists to Administer Flu Vaccine to Patients 14 and Older.   Yesterday, Governor Perdue signed into law S609, which provides in part:  “A pharmacist licensed under Article 4A of Chapter 90 who may administer vaccines under 21 NCAC 46 .2507 and 21 NCAC 32U .0101 shall be granted the authority to administer influenza vaccine to patients aged 14 years and older pursuant to 21 NCAC 46 .2507 and 21 NCAC 32U .0101.”  This provision was effective immediately upon Governor Perdue’s signature.  Accordingly, pharmacists presently authorized to administer vaccines under existing Board rules may begin administering flu vaccine to patients 14 and older.

 



Q: May pharmacists administer the zoster vaccine?

A: Yes. Effective February 1, 2008, pharmacists may administer the zoster vaccine to their patients in accordance with amended Rule .2507.

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Q: May a properly trained pharmacy student administer vaccinations?

A. An appropriately trained pharmacy student may administer vaccines so long as, and only if, that student is doing so under the direct supervision of a certified pharmacist vaccinator.


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