Some local pharmacists question whether CVS and Walgreens have enough staffing to quickly administer COVID-19 vaccinations to Iowa’s nursing home residents by themselves, especially in the state’s hard-to-reach rural areas.
Iowa state officials and company representatives said they believe there are enough pharmacists and technicians to equitably reach all of the state’s long-term care facilities. But independent pharmacists said the national chains’ mass hiring initiatives and efforts to poach already-employed workers point otherwise.
In Des Moines, local pharmacists said a manager from CVS Pharmacy visited multiple Medicap Pharmacy sites and tried to recruit staff to help them vaccinate long-term care residents, said Cheri Schmidt, director of clinical pharmacy for GRX Holdings, which owns Medicap pharmacies in central Iowa.
A flyer handed out to staff read, “Pharmacy and pharmacist tech help need in administering the Covid vaccine in Iowa nursing homes!”
The federal government’s program to vaccinate Iowa’s longterm-care facilities only involve three pharmacies, a move that excludes local pharmacies that already work with their nearby nursing homes on a daily basis.
“It appears independent pharmacies have been locked out of the opportunity to provide vaccine to these communities where we already live,” Schmidt said.
State officials say Walgreens, CVS, assured them ‘they have enough staff’
The Centers for Disease Control announced Oct. 16 that it’s partnering with CVS, Walgreens, and Community Pharmacy, a health care company based in Nebraska, to immunize Iowa’s longterm-care residents. On its site, the CDC said the program aims to reduce workload burdens on hospitals and medical staff who are already caring for sick patients.
Kelly Garcia, interim director of the Iowa Department of Public Health, said she did not know the specific number of pharmacists and technicians employed by Walgreens and CVS in Iowa, after a news conference Dec. 16.
Walgreens operates 72 pharmacies, while CVS has 39 locations. Community Pharmacy operates in Ankeny and Davenport.
Garcia said state officials have been meeting with representatives from Walgreens and CVS to discuss logistics.
State officials initially expected to receive enough Pfizer and Moderna vaccines to provide shots for 172,000 people this month, but the Iowa Department of Public Health announced on Wednesday that their allocation from the federal government could be reduced by as much as 30%. The U.S. Department of Health and Human Services any reduced shipments on Thursday.
Health care workers started receiving immunizations this week. The Iowa Health Care Association said nursing homes should start getting vaccines Dec. 28. It will take three to four weeks for pharmacies to vaccinate Iowa’s 25,500 nursing facility employees and 19,000 residents, according to IHCA.
The second dose is expected to begin Feb. 2 and run through early March, according to IHCA.
“They have absolutely assured us that they have enough staff to make a significant impact in these first several weeks,” Garcia said.
Gov. Kim Reynolds acknowledged during her Dec. 9 news conference that immunizing Iowa’s long-term care residents will place added stress on health care workers.
Pharmacists and technicians will need to visit facilities at least three times for the first vaccine dose and then three more times for the second dose, to ensure they’re immunizing 24-hour staff, Garcia said.
Each pharmacy location is partnered with a care facility within their 75-mile radius, according to Iowa’s vaccination plan.
CVS is trying to hire 110 Iowa technicians by the end of the year, said Charlie Rice-Minoso, spokesperson for CVS Pharmacy.
A spokesperson for Walgreens, declined to share state-specific hiring numbers, but sent a statement saying the company is hiring 8,000 to 9,000 health care providers nationally and offering sign-on bonuses between $500 to $30,000 for eligible roles.
Hy-Vee announced it’s hiring 500 Iowa pharmacy technicians to help expand its COVID-19 testing and eventual vaccine distribution, said Christina Gayman, spokesperson for Hy-Vee. The West Des Moines-based grocery company is Iowa’s largest pharmacy chain with 140 locations, but it is not a part of the federal long-term care program. Gayman said some facilities picked Hy-Vee as an alternative immunization provider.
“It’s going to require just an incredible amount of stress on an already stressed workforce in the state of Iowa,” Reynolds said during her news conference. “We are grateful they have not only the people to allocate and operationalize the distribution but to also give the vaccines.”
Garcia said Pfizer is shipping 975 vaccines per container.
State Rep. John Forbes, D-Urbandale, owns a Medicap Pharmacy in the Des Moines metro, and said the large number of vaccines could create logistical issues for smaller pharmacies. Currently, the CDC is shipping out 974 vaccines per container. Meanwhile, the Pfizer vaccine must go in extreme-cold storage and only lasts in refrigeration for five days. Distributing them to large chains ensures no vaccines accidentally go to waste.
But Forbes said companies will struggle finding hundreds of skilled pharmacists and technicians in Iowa. While Iowa has eased some regulations, technicians still need to become certified and prove they are able to administer vaccines, making it difficult to quickly hire people.
The Iowa Board of Pharmacy has issued 12,399 licenses, but only 6,703 people are currently authorized to practice as of December. Likewise, 18,075 technicians are registered, but only 5,228 actively practice.
Forbes suggested the vaccines could be delivered to local pharmacists who could help administer them.
“The big boys, CVS and Walgreens, have figured out they bit off too big of a piece of the apple here,” Forbes said.
Rice-Minoso said CVS has been hiring staff since the start of the pandemic to prepare for immunizations.
The company will use a “hub-and-spoke” model and store the vaccines at 1,100 locations nationwide. Designated teams of pharmacists will then pick up the vaccines from the stores while they’re on their way to long-term care facilities
Community Pharmacy, which specializes in helping longterm-care facilities, is a part of the federal program because of its partnership with Managed Healthcare Associates, Inc., said Mackenzie Farr, chief operational officer for the company.
She said they already have experience working with facilities within a three-hour radius of its locations.
In Iowa, Community Pharmacy is working with Drake University pharmacy students who need volunteer hours to help with immunizations.
Once they receive the shipments, Farr said the goal is to get the first round of vaccinations finished within 48 hours.
“One of the biggest things we’ll ever do in our professional careers is the opportunity to be in the forefront of this,” Farr said.
Walgreens declined to share its Iowa-specific plans.
Rural and independent pharmacies want to help
Initially, the Medicap Pharmacy in Audubon was picked to help residents at a local long-term care facility next door, Schmidt said.
But the facility ended up getting a call from the state, letting them know their immunizations would be provided by Walgreens instead.
The nearest Walgreens to Audubon is 78 miles away in Des Moines.
“A lot of times they’re not in these rural areas,” Schmidt said. “They don’t have a relationship with these patients.”
In Taylor County, Bedford Pharmacy is one of two pharmacies available for residents to come and fill their prescriptions, receive their immunizations and ask their healthcare questions.
The southern Iowa county has no hospital. There are three clinics in Bedford where young physicians and doctors practice for several years, as part of a loan forgiveness program that brings skilled medical doctors to town to treat residents before they move on to a bigger city.
Pharmacy owner Michael Schweitzer took over the 55-year-old pharmacy from his father. He sees around 1,000 regular customers.
”We see the patients more than the doctors do,” Schweitzer said. “They’re in here at least monthly.”
When the CDC announced its partnership with Walgreens and CVS, it didn’t make sense to Schweitzer when none of the chains’ stores are located in the county.
“We’re 100 to 125 miles away from the closest Walgreens or CVS in the state of Iowa and 80 or 90 from the closest one in Missouri,” Schweitzer said.
Lindsey Ludwig, executive director of CPESN-IA, a network of 112 pharmacies across the state, said she’s offered to contract with CVS and Walgreens to help them administer vaccinations.
Ludwig said she hasn’t heard back.
“It’s going to be a big lift for whoever does it,” Ludwig said
In the meantime, 350 pharmacies have already signed up to help with vaccine distribution once it opens to the general public, according to the Iowa Pharmacy Association.
As Iowans prepare to receive immunizations next year, rural access to pharmacies will be critical, Schmidt said.
When the Moderna vaccine is available, Schmidt said most pharmacies will be able to store them because they have a 30-day refrigerated lifespan.
Once local pharmacies receive the immunizations, Ludwig said they’ll be instrumental in distributing them. From providing education to operating outside of regular business hours, she said pharmacists are prepared to help.
“Overall, the most important piece is that people are vaccinated,” Ludwig said. “The state needs to make decisions on allocations for COVID vaccine distribution and I think they tried to find what they felt was the best initial solution. We’re still interested in being part of that solution if an opportunity exists.”