Pharmacies countrywide are adding immunizations to their services, but running a successful program goes beyond simply adding vaccinations to the menu. Ten steps that will help independent pharmacies thrive in this growing niche were outlined by Pam Marquess, PharmD, of East Marietta Drugs, Marietta, Ga., during a recent program sponsored by The Institute of Wellness and Education during the McKesson ideaShare 2012 meeting in Las Vegas. 1. Know your state policy Pharmacists across the country are administering various vaccines to prevent influenza, pneumonia, and zoster virus, but not all states give pharmacists the same authority. Each state has its own pharmacy practice act dictating which vaccinations pharmacists may deliver. Before you begin an immunization program, Marquess said, check with your state board of pharmacy to see what is allowed where you work. 2. Identify target populations Immunization levels are not yet optimal. Community pharmacists can help close the gap by identifying target populations that could benefit from flu shots and other vaccines. One of the largest groups is the elderly, and they are the easy target, Marquess said. "You take the customers you already have, and you just expand your service level to them." Another target population is patients with chronic diseases such as lung disease, heart disease, or diabetes. These patients, Marquess said, can be identified through a quick computer database search. 3. Training Proper training and certification is essential to a successful immunization program. The American Pharmacist's Association offers pharmacy-based immunization-delivery certificate-training across the country. 4. Market your program Once your immunization program is in place, it's time to spread the word. Marquess starts her own flu-season marketing efforts in July using the media, store signs, postings on Facebook, flyers, direct mailings, and word of mouth. She even calls local businesses like churches and banks that might benefit from working with the pharmacy. 5. Contract with third-parties Another important factor for success is signing contracts with third-party payers. Marquess said these agreements, often part of an addendum contract, are essential to expanding your services to a greater customer base. "We've really come into a new era, where so many third parties are paying for pharmacists to vaccinate," she said. "In some states, even Medicaid pays for pharmacists to vaccinate." 6. Order vaccine Deciding what vaccines to order isn't always easy. Several core considerations include staffing, vaccine procurement, storage and handling, legal requirements, and reimbursement. For the 2012-2013 influenza season, influenza virus vaccines Fluzone, Fluzone High-Dose, and Fluzone Intradermal are approved by FDA. Each formulation has its own indications, precautions, and dosage instructions. For more information, go to 7. Bill through Medicare Medicare reimbursement rates vary by location. If independent pharmacies want to offer competitive and successful immunization programs, Marquess said, it's essential that they bill through Medicare. "The largest group you will service are Medicare-age patients," she said. "They expect to receive the flu vaccine at no cost, because it's a standard of practice to bill Medicare." 8. Administer the vaccine To reach the most people, Marquess said, her pharmacy offers in-store vaccinations and off-site clinics at local churches, businesses, and community events. Off-site clinics can be a convenient and accessible way for people to get their annual flu shots and can expand a pharmacy's reach within the community. "You're meeting them at their work site, which really increases their likelihood of getting the flu shot," she said. 9. Handle adverse reactions Not everything always goes as planned. When it doesn't, it's important to be prepared. Pharmacists delivering immunizations need to be properly trained in emergency protocol and should practice their responses before an emergency arises. Marquess recommends having an emergency kit on hand, containing epinephrine, a diphenhydramine injectable or oral tablet, syringes, a sphygmomanometer, stethoscope, wristwatch, and tourniquet. 10. Partner with other providers The influenza vaccine has been associated with reductions in hospitalization rates, pneumonia, and death. Marquess said the best way to continue to improve community health through increased immunization rates is to partner with other healthcare professionals and groups. "The team approach is extremely important to continue to promote the message of how important vaccinations are," she said. Jill Sederstrom is a freelance writer based in Kansas City.