Influenza vaccine in pharmacies

We propose changes to the Pharmaceutical Schedule to fund the provision of influenza vaccine (flu vaccine) to people 65 years and over and pregnant women in community pharmacies.

Please provide your feedback to this proposal by 24 February 2017.

What we’re proposing

We propose changes to the Pharmaceutical Schedule to fund the provision of influenza vaccine (flu vaccine) to people 65 years and over and pregnant women in community pharmacies.

What would the effect be?

From 1 April 2017 people 65 years and over, and pregnant women would be able to get free flu vaccine from a community pharmacy. This would mean that these people would be able to choose to get their funded vaccine from their general practice or pharmacy.

Pharmacies would be able to claim an administration fee and funded vaccine for these eligible people.

There would be no change to vaccines given by general practice.

Those aged 64 years and under (including children) who are eligible for a free flu vaccine are not covered by this proposal. These people would still need to visit their general practice to get a free vaccine. The full list of eligible people for funded flu vaccine is available on the PHARMAC website.

Changes to the National Immunisation Register and funding arrangements between Pharmacy and DHBs are underway to support this change. See Details section for more information(external link).

Who we think will be interested in this proposal

Doctors in general practice, pharmacists, nurses, vaccinators, midwives, DHBs, people 65 years and over, women who are pregnant or may become pregnant, organisations with an interest in immunisation.

About flu vaccine and pharmacist vaccinators

Influenza vaccine (flu vaccine)

Influenza, commonly called the flu, can be a serious illness that is sometimes fatal. Infection with the influenza virus may lead to a stay in hospital for any age group but particularly if you are elderly or have an ongoing medical condition. Influenza can worsen existing medical conditions such as asthma or diabetes.

Flu vaccine is funded each year for a range of people, including those 65 years and older, women who are pregnant, and people with medical conditions such as heart disease, respiratory conditions, diabetes, renal disease, and autoimmune diseases. Over 1.2 million people are vaccinated annually (funded and privately purchased). In 2016, 67% of over 65 year olds were immunised and only 49% of Māori people over 65 years were vaccinated.

Influenza immunisation can be given during any stage of pregnancy. Around 18% of pregnant women were immunised last year.

PHARMAC has previously announced that Influvac is the funded brand of vaccine for the 2017, 2018 and 2019 influenza seasons. Further details can be found in the notification on the PHARMAC website.

Pharmacist vaccinators

Since 2011, a number of vaccines have been reclassified by Medsafe from prescription medicines to restricted medicines (also known as pharmacist only medicines) when administered by a registered pharmacist who has successfully completed a vaccinator training course (VTC) approved by the Ministry of Health.

Pharmacists must meet the same immunisation and quality standards of the Ministry of Health as other vaccinators in order to deliver this service. More information on Pharmacist Vaccinators can be found in the online Immunisation Handbook(external link).

Currently there are pharmacist vaccinators working in around 300 community pharmacies across New Zealand. Not all pharmacists are qualified vaccinators.

Why we’re proposing this

To improve uptake for eligible people and provide another convenient option for people to get protected against flu.

The Ministry of Health has identified that there are vulnerable eligible groups in the community who would benefit from having a flu vaccine. People aged over 65 years and pregnant women are at increased risk of hospitalisation from flu-related cardiorespiratory disorders. Vaccination has been demonstrated to reduce the risk of hospitalisations and death in these groups.

This proposal would support the health system to provide care for people closer to home. It would make good use of the skills of the health workforce and potentially increase collaboration between community pharmacy and general practice. DHBs would be able to fund flu vaccines given by pharmacists or other approved vaccinators within a community pharmacy. The Ministry of Health’s policy is to enable community pharmacists to vaccinate where appropriate and wants to expand pharmacists’ access to the funded flu vaccine in time for the 2017 Influenza Immunisation Programme.

Details about our proposal

We propose the following changes in Section A and Section I of the Pharmaceutical Schedule to enable pharmacies to claim for funded influenza vaccine.

Section A proposed changes

We would add a new definition of “Vaccinator” into the General Rules, being:

“Vaccinator”, means either:

  1. a Pharmacist who has successfully completed a vaccinator training course approved by the Ministry of Health and who is complying with the immunisation standards of the Ministry of Health; or
  2. any other person who is authorised by the Director-General of Health or a Medical Officer of Health to administer vaccines in accordance with this Section 44A of the Medicines Regulations 1984.

“Vaccinator” would be included in the definition of “Practitioner”

We would add a new rule 3.7 (“Vaccinators’ Prescriptions”) to the General Rules, being:

3.7        Vaccinators’ Prescriptions

Prescriptions written by Vaccinators will only be valid for subsidy in accordance with an agreement between the Contractor and the DHB, and only for direct administration of a vaccine to a patient.

Section I proposed changes for influenza vaccine

We would remove the “Xpharm” restriction from the listing of influenza vaccine, and add an “only on a prescription” restriction.

We would add a “no patient co-payment payable” flag to the listing of influenza vaccine.

Paragraph B of the restriction for influenza vaccine would be replaced with the following:

Contractors will be entitled to claim payment from the Funder for the supply of influenza vaccine to patients eligible under the above criteria pursuant to their contract with their DHB for subsidised immunisation, and they may only do so in respect of the influenza vaccine listed in the Pharmaceutical Schedule.

A new paragraph would be added to the listing restriction for influenza vaccine as follows:

Contractors may only claim for patient populations within the criteria that are covered by their contract, which may be a sub-set of the population described in paragraph A above.

How would it work?

Reimbursement for the cost of the flu vaccine ($9 per dose (ex-manufacturer, ex GST)) will be via the Community Pharmaceutical Budget (CPB) managed by PHARMAC which is the same mechanism used by DHBs to reimburse general practices. Rebates on the price of flu vaccine would apply to pharmacist claims as they do the GP claims. Rebates would reduce the net price to the funder (DHBs).

The Ministry of Health has been working on the technical changes required to make it possible for pharmacies to provide funded flu vaccine:

  • The National Immunisation Register (NIR) has been updated to accept vaccinations given in a pharmacy via a secure web browser application called “Immunise Now” so that there is a record of vaccinations given.
  • Work is underway with DHBs to amend the existing Community Pharmacy Service Agreement (CPSA) to allow payment for this additional service.

What does it mean?

For people 65 years and older and pregnant women

Funded flu vaccine would be available from GPs, other approved vaccinators and also from community pharmacies with a Pharmacist Vaccinator or other approved vaccinator.

People who have been vaccinated in a pharmacy and have access to a patient portal could use this system to let their GP know, however general practice should also receive this information from the pharmacy (see below).

For Pharmacies

Pharmacies could claim reimbursement for the cost of the publicly funded flu vaccine and an administration fee set by DHBs via a Part P variation to their CPSA.

Pharmacists would be able to update the NIR to record all flu vaccines given (funded and unfunded) via Immunise Now.

Pharmacies would need to order their funded flu vaccine directly from Healthcare Logistics.

For General Practice

GPs and approved vaccinators would continue to provide funded vaccines to all eligible people.

General Practice would receive an electronic notification when a person was given their flu vaccine from a pharmacy, if the person had previously received a vaccine from their general practice recorded on the NIR. This would happen for people receiving both funded and unfunded vaccines.

If a person has not received a vaccine from their general practice before and was vaccinated in a pharmacy, a GP would be able to retrieve this information from the NIR via their patient management system (PMS). As is currently the case, pharmacist vaccinators will be required to notify the individual’s general practice that they have administered a flu vaccine to their patient.

To provide your feedback to this proposal

Send us an email: vaccines@pharmac.govt.nz by 24 February 2017.

All feedback received before the closing date will be considered by PHARMAC’s Board (or its delegate) prior to making a decision on this proposal.

Feedback we receive is subject to the Official Information Act 1982 (OIA) and we will consider any request to have information withheld in accordance with our obligations under the OIA. Anyone providing feedback, where on their own account or on behalf of an organisation, and whether in a personal or professional capacity, should be aware that the content of their feedback and their identity may need to be disclosed in response to an OIA request.

We are not able to treat any part of your feedback as confidential unless you specifically request that we do, and then only to the extent permissible under the OIA and other relevant laws and requirements. If you would like us to withhold any commercially sensitive, confidential proprietary, or personal information included in your submission, please clearly state this in your submission and identify the relevant sections of your submission that you would like it withheld. PHARMAC will give due consideration to any such request.