Vaccine Resources

Challenges in Adult Vaccination: Policy Strategies for Sustaining Access and Supply

Challenges in Adult Vaccination: Policy Strategies for Sustaining Access and Supply” is a critical policy paper shedding light on the benefits associated with the current vaccine access and payment model for adult vaccination in the United States. It highlights the potential negative consequences if Pharmacy Benefit Managers (PBMs) subvert the vaccine reimbursement landscape, which would in turn undermine the important public health role that pharmacists play.

Authored by Robert Popovian, PharmD, MS, Founder, Conquest Advisors and GHLF’s Chief Science Policy Officer, the report brings to light the problematic practices of PBMs that can limit patient access and disrupt the vaccine supply.

The report explains that PBMs complicate the vaccine distribution process by enforcing restrictive policies involving delayed payments, complex authorization processes, or insufficient reimbursement rates. These practices not only jeopardize the financial stability of pharmacies but also limit the range of vaccines that pharmacies can offer patients.

“Pharmacists are tasked with providing essential health services, including vaccinations. Suppose PBMs are allowed to impose access restrictions by providing inadequate reimbursement for the sole purpose of profiteering. Such actions would disrupt the current vaccination ecosystem in pharmacies, which ensures strong patient access, and critically, could endanger the long-term vaccine supply.”

— Robert Popovian, PharmD, MS
Chief Science Policy Officer at GHLF

Report Highlights

Vaccines are one of the most clinically meaningful and cost-beneficial interventions in health care.

According to researchers Stanley A. Plotkin and Edward A. Mortimer, “the impact of vaccination on the health of the world’s peoples is hard to exaggerate. With the exception of safe water, no other modality has had such a major effect on mortality reduction and population growth.”

Unlike medications, where high out-of-pocket costs burden patients, all insured individuals, irrespective of age or insurance coverage, have zero out-of-pocket costs for the vaccines they are eligible for in the U.S. Thus, all vaccines recommended by ACIP or the Food and Drug Administration (FDA) and approved for adults must be covered through Medicare, Medicaid, and private insurance without any out-of-pocket cost for adults. Administrative burdens such as prior authorization, tiering, and formulary exclusions are prohibited or unnecessary.

Pharmacists are the most accessible health care professionals in the U.S.

Pharmacists and pharmacies play a crucial role in adult vaccine access in the U.S., where 88.9 percent of individuals live within five miles, and 96.5 percent live within 10 miles of a community pharmacy.

Overall, adult patients prefer going to a pharmacy for their vaccination(s). A report published in 2023 by IQVIA Human Data Sciences and Global Healthy Living Foundation found that post COVID-19 pandemic, almost 90 percent of adult vaccinations occur at a pharmacy.

Pharmacies are far more accessible in low-income neighborhoods where ethnic and racial minority adults are overrepresented.

The role of pharmacists in underserved communities has expanded beyond traditional dispensing functions. A study published in 2021 in the Journal of American Pharmacists Association found that pharmacies and pharmacists are far more accessible in low-income communities than physician practices, especially when hours of operation are considered. Such access is vital for patients who cannot easily receive vaccinations during typical work hours, lack flexible work schedules, and cannot take time off work during regular work hours when most physician offices are open. Most importantly, racial and ethnic minorities are overrepresented in low-income communities, which makes immunization access through a pharmacist an essential objective in addressing health disparities.

Call-to-Action for Competitive Market Reforms

The paper calls for safeguards preventing PBMs from limiting competition and restricting vaccine access. It also highlights the continued coverage of all adult vaccines by private and public insurers, maintaining the current payment model for easy vaccine access and allowing patients to receive vaccinations at community pharmacies without incurring out-of-pocket costs.

Dr. Popovian further emphasized the broader impact of these reforms, “Implementing these policies will not only enhance vaccine accessibility but also strengthen the overall health care system,” he says.

“Pharmacists are on the front lines, particularly in areas where other health care services might be limited. It is vital for the people whom pharmacists serve that PBMs are not permitted to manipulate or restrict access to vaccines, medications or services that are imperative for public health.”

— Steven C. Anderson
President and CEO, National Association of Chain Drug Stores

To download the full report,
please provide your email address below.



Robert Popovian, PharmD, MS
Chief Science Policy Officer at GHLF

Dr. Robert Popovian is the Founder of the strategic consulting firm Conquest Advisors. He also serves as Chief Science Policy Officer at the Global Healthy Living Foundation, Senior Healthy Policy Fellow at the Progressive Policy Institute, and Visiting Health Policy Fellow at the Pioneer Institute. He previously served as Vice President, U.S. Government Relations at Pfizer.
One of the country’s foremost experts on every significant facet of biopharmaceuticals and the healthcare industry, he is a recognized authority on health economics, policy, government relations, medical affairs, and strategic planning.
Dr. Popovian completed his Doctorate in Pharmacy and Master of Science in Pharmaceutical Economics and Policy degrees with honors at the University of Southern California. He has also completed a residency in Pharmacy Practice/Adult Internal Medicine and Infectious Diseases at the Los Angeles County-USC Hospital and a fellowship in Pharmaceutical Economics and Policy at USC.
Was this article helpful?
Back To Top