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A summary of presentations from the weekly Summit partner webinars

December 19, 2024 – The latest Summit Summary

Missouri Pharmacy Project – Carson Van Alst, PharmD, Executive Fellow, Missouri Pharmacy Association, and Tyler Wood, PharmD, MBA, Employer Pharmacy Benefits and Pharmacy Expert

Carson Van Alst, PharmD, and Tyler Wood, PharmD, MBA, gave an update about the Missouri Pharmacy Project.

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As an introduction to the first presentation, Carolyn Bridges, MD, FACP of Immunize noted that, although there has not been a vaccine counseling code for adults as a Medicare benefit, a code will be available in January 2026 for Medicare for vaccine counseling when a vaccine is not given to an adult after vaccine counseling.

Missouri Pharmacy Project – Carson Van Alst, PharmD and Tyler Woods, PharmD, MBA
Community Pharmacy Enhanced Service Network (CPESN) is a clinically integrated network; the majority of states have their own chapter. This presentation was specific to Missouri. CPESN looks for opportunities to fill gaps where care isn’t being received that should and could be. Understanding that not every pharmacy is the same, CPESN works with like-minded pharmacies, predicated on community health engagement and improvement.

Value or Quality Is Somewhat Subjective
For example, increased value could differ between urban and rural areas, but knowing that not one size fits all allows CPESN to focus on being the disease state management experts. Measures include the following:

  • Patient Engagement
  • High Touch Points
  • Access of Care
  • Quality of Care

Cross-Training Pharmacy Technicians to Be Community Health Workers (CHW)
In Missouri, with 190 pharmacies across the state, there is network adequacy within CPS and pharmacies AND community health workers. There is a lot of reach and the ability to impact large to small communities. The CHWs allow for talking touchpoints and community engagement practices that are valuable to the communities CPESN represents.

Training Pharmacy Techs as CHWs
This approach allows for connecting the clinical aspect of care with the social and community aspect, and the broad access for patients to reach a CHW/tech in a pharmacy offers convenience and access.

Pharmacy [Vaccine] Gap Closure Program
This program began as a grant specific for COVID vaccination to the un- or under-insured. The introduction of the Bridge Program made the initial grant activity obsolete, because they could not reimburse for the vaccine. The grant project pivoted to the current plan. The grant is a contract with the Department of Health and Senior Services, Bureau of Immunizations.

  • The framework of pharmacy technicians were trained as community health workers in community pharmacies across Missouri to assess and close care gaps by focusing on addressing health disparities in addition to increasing access to health information and care coordination.

Why Pharmacies
The frequency of care delivered differs between primary care visits (3.5x/year) and pharmacy visits (35x/year). The large number of touchpoints with patients, family, friends, people in the community, etc. is invaluable.

  • In-Pharmacy Operations
    • Longitudinal Care Process (using Med Sync program as a template): The request to pharmacies is to implement Social Determinants of Health (SDOH) screening and have vaccine hesitancy conversations with patients, based on frequency of contact and positive relationships with patients.
      • The entire pharmacy team and established software that works in sync to establish ongoing counseling and follow up for patients in a community pharmacy.
        • The Service Outline
          • Eligible patients are screened by the pharmacist prior to care calls.
          • Patients are counseled on appropriate vaccinations by the pharmacist during medication synchronization care calls.
          • Pharmacy technicians trained as CHW in the pharmacy provides additional outreach regarding potential vaccine hesitancy or other issues related to vaccination issues.
        • Why It Works
          • Workflow model already exists, including personnel and software
          • Established relationships and rapport with patients
          • Scheduled pharmacy calls mean patients answer the phone
          • Multiple touchpoints, including medication pick-up/delivery

Expanding to Community Reach

  • Community Care Clinics operate outside of pharmacy business walls or normal operation hours.
  • Vaccine Gap Closures occur through CHW care coordination and verification/follow up. (Appointments made did not have to be at the participating pharmacy and follow up calls included addressing barriers for the missed appointment.)

Data (January to September 2024)

  • With Vaccine Hesitancy and Education Interventions, 70,000+ interventions were completed.
  • More than 500 providers enrolled in the program, including pharmacists and CHW/technicians.
  • More than 12,000 vaccine gaps were closed in the August and September community care vaccine clinics alone.
  • There were 132 October health-equity-focused vaccine clinic requests.

 Key Take-aways

  • The grant ended on October 1, 2024, so some vaccine gaps that could have been closed (estimated at 6,300+) were not. Based on the success with closing vaccine gaps and the difference that pharmacies can make, the project is looking to use the strategy with other diseases, such as asthma and diabetes.
  • The impact and number of interventions occurred during a typically quieter time in pharmacies for vaccinations. Pharmacies often do 10 to 15 times the volumes for vaccines in the September to December time frame than in the timeframe represented.
  • This opportunity demonstrated that the strategy works for vaccine gaps, but also may work for other care gaps. Community pharmacies may be overlooked for the value they can bring to the health care system but can often move the needle on overall community health.

QUESTIONS & ANSWERS

Q: Can you provide suggestions for others who are considering this dual training of pharmacy technicians or maybe other kinds of workers to be community health workers? How challenging was this dual training and certification?
Carson Von Alst (Missouri Pharmacy Assoc): So, in Missouri, it was kind of crazy. We have a pharmacist in the southeast and he was on his local board for this health department and they were training community health workers. And he said, “I think this is what my pharmacy technicians are already doing on a daily basis.” So, working with him, we actually created a course that was pharmacy-specific. So, through that channel, it made it a lot easier for us because we just kind of made our own curriculum in the state of Missouri. But I’d say looking at the whole, the community health workers has kind of changed a lot of ways that people look at our network in Missouri. Those who originally weren’t having conversations with us are seeing the benefit of having them in the pharmacy right there with all the touchpoints that we talked about and they were like, ‘I think we should work together a little bit more.’ But, Tyler, you can add on to anything you have.
Tyler Wood (Employer Pharmacy Benefits and Pharmacy Expert): Yeah, I think you nailed it. And I think the next steps if there’s anybody interested, I’ll have a training program that is offered. And really, it’s not an intense program. It’s pretty straightforward, you know, usually over a weekend or something in that capacity. Often times we have both live and virtual options. So it’s out there.

Q: How does what you’re doing now differ from a normal MTM or a medical therapy management intervention? And, also, would you like technicians to conduct interventions of other disease states that you mentioned, like diabetes, for example? So how is this different from MTM?
Tyler Wood (Employer Pharmacy Benefits and Pharmacy Expert): Yeah, I would say the difference is conceptually it’s the same or very similar but operationally it goes a step or two further and, because collecting those data points to be able to reflect and report back to what those interventions or engagements that produced is very vital. So, an MTM has similar structure, but this project really goes a few steps beyond that. And, then, from that standpoint, the answer is absolutely yes. Our CHWs are so vital in this because not only are they able to kind of identify needs, but often times educate for solutions that patients didn’t know were available. We run into that a lot, especially in the Medicaid space where there’s certain benefits that are available to these patients that they’re just not aware of. And it’s no fault from the Medicaid plan because they try to get that information out. But sometimes the timing of the message is as important as what the message is. So, the second one’s an absolutely yes answer.

Q: A clarifying question: Might the difference be that with an MTM you could administer the vaccine on the same day, but in this, using these codes, the vaccines can’t be administered on the same day that the counseling is provided?
Carson Von Alst (Missouri Pharmacy Assoc): Yes, you’re correct because when we were initially planning the grant, the whole part of the documentation was basically building out how we’re going to be able to bill the Medicaid and MTMs. So that’s kind of what we based it off. And, then, it kind of started evolving a little bit as we added more parts to it. But I think you’re correct on that first part. And, also, the CHWs were not getting reimbursed in Missouri. So this was also helpful showing CHWs can perform this vaccine hesitancy counseling and they should be able to bill for it.

Q: Can you talk about the sustainability of your efforts and what kind of funding would be needed now that your initial grant has ended?
Carson Von Alst (Missouri Pharmacy Assoc): We’ll let Tyler talk about it because he’s almost got us a contract that we’re going to be able to get paid for.
Tyler Wood (Employer Pharmacy Benefits and Pharmacy Expert): The sustainability is probably the most exciting part of this because this just scratches the surface of that proof of concept that you mentioned, Carolyn, on using and utilizing community pharmacies and CHWs inside of those pharmacies. The opportunities are somewhat endless. And so I think when it comes to the question of funding in those kinds of conversations, it really kind of comes down to what the goal is and who the goal is for, right? So, if it’s an MCO plan or if it’s an employer benefit, they may have different goals of what they’re trying to do, right? Cost savings versus outcomes. And all those types of initiatives come into the conversation, but having the ability to now prove this concept is really the exciting part because the sustainability and really the reach of this as a potential is very, very vast. So, I would say really it’s just somewhat predicated on what gap we’re trying to close, what initiative we’re trying to improve patient health. And then that point is kind of the size, the direction of funding needs and really what the engagement exercises will look like.

Q: Will your training course be available in other states? And, follow-up question: would this be a state-by-state certification program?
Carson Von Alst (Missouri Pharmacy Assoc): Yes, we started in Missouri where we built it, but we’ve actually — CE Impact runs the community health worker course and I believe they are good. And, if it’s not all 50 states, it’s in the high 40s. The CE Impact CHW link is https://www.ceimpact.com/chw/.

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State of Anti-Vaccine Legislation – Northe Saunders, Executive Director, SAFE Communities Coalition, and Abby Bownas, Manager, Infectious Disease Prevention Network (IDPN) / Partner, NVG LLC

Northe Saunders and Abby Bownas gave an update on the state of anti-vaccine legislation.

The Infectious Disease Prevention Network (IDPN) was established about 3 years ago with the goal to give workers on the front lines, in states, the tools and resources to succeed in pro-vaccine policy efforts. There is a growing need to support policies and the vaccine ecosystem. The IDPN is completely advocacy. Activities include the following:

  • Policy support, training and technical assistance
  • Grassroots capacity to educate state legislators
  • Enduring advocacy capabilities
  • Communications strategies
  • Diverse partnerships to demonstrate depth of pro-vaccine sentiment

Federal Landscape
Although IDPN is a state coalition, it keeps track of activity on the federal level. Coming into the next Congress in January 2025, with Republican majority and presidential nominees for health positions, the process is underway. Nominations for health positions, which will face Senate review, include the following individuals who, if confirmed, will have an impact on both the federal and state level:

  • HHS: Robert F. Kennedy
  • CMS: Mehmet Oz, MD
  • CDC: Dave Weldon, MD
  • FDA: Marty Makary, MD
  • Surgeon General: Janette Nesheiwat, MD

There will be a lot of policy activity on the federal and state levels in January and February and, so, many opportunities for vaccine advocates to share good information on vaccines and vaccination.

  • On the state level, there are 15 Democratic trifectas, 23 Republican trifectas, and 12 divided governments; in those states with trifectas, vaccine legislation could move quickly.

Overview of Bills Monitored in 2024
In 2024, IDPN tracked more than 380 bills, the vast majority of which were negative for vaccines, e.g., removing requirements, rights to refuse, limiting or slowing infrastructure.

  • In 2025, more of the same is anticipated — fewer bills than at the height of the pandemic, but much more coordination among bills introduced and similar themes, with less resistance.
  • Bills have been pre-filed for 2025, including those that would introduce criminal liability for vaccine manufacturers and doctors, immunization exemptions, prohibition of COVID-19 mandates, and more.

Efforts to support pro-vaccine policy are important. Please consider signing onto a value statement from the Council of Supporters of the IDPN. Information on the Council can be found at: https://docs.google.com/document/d/1M3vqHVytSPgTIAbx6TPVNWdT8D6TgxiA/edit, and you can sign on at: https://docs.google.com/forms/d/e/1FAIpQLSdb1Y-zdI8R_24RvJFzxvwo8Mi3y8FFddCxAp0CIQD50RccoQ/viewform?pli=1.

2024 State Legislative Recap

The focus of Safe Communities Coalition is to recruit, train, and empower grassroots advocates to build relationships with lawmakers.

  • SAFE Overview: Grassroots advocates show up in statehouses and meet other advocates within the community; SAFE makes sure that advocates have resources and support.
    • There are chapters in 9 states and New Hampshire and West Virginia are being added.
  • Anti-Vaccine Organizations & Activity: These organizations have been around for a long time and are well-resourced – over $60M was raised in 2024. Many states have multiple anti-vaccine groups.
  • State Policy Update
    • Coming out of the pandemic, anti-vaxxers did not get the wins they wanted.
    • The volume of legislation has slowed down but is still high (i.e., down from 1,500+ annually at the height of the pandemic to nearly 500 bills nationally in 2024).
    • Anti-vaxxers are savvy: they are introducing legislation to the judiciary or finance committees, so vaccine advocates have to educate the members of those committees about the complex issues.
    • Small and incremental changes chip away at pro-vaccine policies (e.g., to foster care or child care policies).
    • Good news includes the following:
      • groups organizing at every level to respond to threats
      • the development of a culture of advocacy
      • the building of a culture of advocacy
      • exploration of non-traditional partnerships
      • in some states, pro-vaccine legislation may be passed in the coming legislative session
      • progress on adult registries
      • funding for immunization programs
    • Pharmacists administering vaccines is a big win.
  • Anti-Vaccine Trends in 2024
    • In schools – increasing exemptions, removing requirements to show vaccination records, removing certain vaccine requirements for attendance, notifying parents of exemption information
    • For childcare – vaccine requirements are falsely being identified as a reason for childcare shortages and recruitment challenges in many states
    • Limitations on Vaccinated Blood – blood donors must report vaccination status, recipients could request non-vaccinated blood, requiring tests (even non-existent ones) for donated blood
    • mRNA Vaccines – labels for “mRNA free” meat, food that has received a vaccine must be labeled as a drug, preventing State Veterinarian from administering vaccines in an emergency situation, banning mRNA products
    • Discrimination – preventing employment discrimination based on vaccination status, preventing employers from requiring mRNA-specific vaccines, ability to sue employers for harm by employer-required vaccine, ban on businesses refusing services based on vaccination status, discrimination in a school setting
    • World Health Organization – preventing states from using WHO recommendations to justify policy, opposing WHO pandemic agreement
  • Forecast for 2025 Legislation Session
    • The Trump administration will have dramatic implications for state policy:
      • Funding
      • mRNA
      • Misinformation about safety and efficacy
      • Broadening exemptions
      • Childcare rules
      • Healthcare worker requirements
    • 2025 Vaccine Policy Forecast
      • “Message” bills designed solely to erode confidence
      • Interim hearings/committees focused on misinformation
      • Need to educate legislators about basic science
      • Rulemaking process
      • School board action regarding vaccines
  • Suggestions for Legislative Activity that Makes a Difference
    • Align with state culture and norms
    • Attune to legislative landscapes
    • Host days of advocacy and other events
    • Strengthen constituent relationships with lawmakers
    • Build community engagement
    • Offer advocate training and education
    • Engage diverse, non-traditional partners
    • Leverage policy experience and legislative analysis with partners and allies
    • Provide district- and lawmaker-specific resources
    • Recognize lawmaker champions
    • Engage the media

QUESTIONS & ANSWERS

Q: How can public comment be used?
Abby Bownas (IDPN/NVG LLC): It’s really important to use any opportunity. So write to your members when there’s public comment for testimony. Often, members are looking for a request for information. The Federal Register puts out common opportunities all the time on federal rules that people weigh in on regarding the vaccine provisions. There are a lot of chances along the way. But, for advocacy, it’s about doing what you have time to do. The SAFE Communities’ family chapters are doing legislative days in all the states that we’re working in. So that’s a great opportunity to give your assistance. One day, but if you don’t have time for a whole day, you can make a phone call or set up a meeting on your own time. Regarding the nominations process, right now, it’s really being a resource and reaching out and talking to your senators and saying, “Hey, if you have any questions on vaccines, I have expertise in this space, I’m happy to be a resource.” You do not need to say anything about candidates. You can just offer yourself as somebody that knows this issue inside and out, and that you’re happy to be a resource to them. And that’s all important.

Q: How might funding be restricted to affect school-based immunizations?
Northe Saunders (SAFE): Yeah, I think there’s been statements made by president-elect Trump that said that he would limit federal funds to schools that had immunization requirements. His campaign subsequently contextualized that, saying he was talking about COVID. He hasn’t necessarily withdrawn that. And, so what I think, that’s the quickest way that they could kind of limit funding for schools that have immunization requirements. And there are a lot of federal dollars that flow from the government down to the states through the Section 317 program, through other programs, through the CDC. And so I think funding from the federal government for immunization programs is definitely a concern of many people.
Abby Bownas (IDPN/NVG LLC):I’m going to note here we are in the nation’s capital today, they are still trying to work on a continuing resolution for the FY25 funding bill. And we thought it was close, but there’s still a way to go before they leave town to finish that up. That will just push the funding from this year to March with a three-month CR. But just to note that next year’s FY26 process will begin once, you know, the federal budget gets released after February. So, between probably March and June is when they’ll really get working on appropriations for next year. And those are those funding lines for all the different agencies and sub agencies within CDC, the immunization program or the Section 317 program. And, so, that’s what, as advocates, we’ll want to be supporting at as high a level as we can. But knowing that, overall and just about vaccines, there could be quite a number of cuts to the budget. People will be dealing with a lot less when it comes to the agencies. So, it will be a tough environment for everybody really to gather around and really make the case for what these programs do and why they’re so important. And we’re going to be putting something into the chat soon.
L.J Tan (Immunize): Immunize.org does have a website where we list all the specific school entry requirements and exception policies in the states. And I think it’s important to recognize that while we’re an adult and flu Summit, I think at this point in time moving to 2025, we think there’s the need to cross support each other. I mean, this is a unified immunization effort now. Pediatric school entry requirements are under real threat. And I think even though we may be advocates for adult vaccines, I think we must step forward with some of these actions that are going on in schools. And so, folks, just do what you can.
Northe Saunders (SAFE): We’re here to help. And I think one of the things that we’re thinking about at SAFE, and that we have grassroots advocates that we’ve recruited to help with state policy issues, is how we can deploy them with support, you know, to support some of the federal issues. And, so, if you have ideas or thoughts on that, I certainly look to L.J and Abby and others that kind of keep their finger on the pulse of federal issues.

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