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Moving the Needle: Turning Immunizations into Year 

Round Profits

Justin Wilson, Pharm.D.www.oupharm@mac.com

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Disclosure

• Justin Wilson, PharmD, Valu‐Med declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

Learning Objectives

• Outline a plan for evaluating the expansion potential of vaccination services in your market.

• Discuss effective methods for marketing vaccination services to patients and prescribers.

• Describe effective tools and resources to improve your vaccination process.

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Spot Quiz

• Are there corporations in your area that conduct international business?

•Do you fill or write prescriptions for retirees?

•Do you have patients asking about the New Pneumonia shot?

•Do your patients have trouble finding someone who stocks shingles vaccine?

•Do the colleges in your area have study abroad programs?

•Do you have churches, synagogues, or mosques that sponsor mission groups?

•Do families in your area adopt children from other countries?

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Agenda

• Immunization Market Overview

•Developing Your Business Plan

• Core Elements

• Business Plan Considerations

• Initial Setup

• Training

•Marketing

•Startup Timeline

•Discussion and Recommendations

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Immunization Market Overview

Expanded Immunization Services: Practice Builder•Preventive medicine

•Community need

•Low awareness

•Few access points

•Year round immunization business

•Healthy revenue per patient

•Typically a cash business

•Augments pharmacy traffic

•Ability to position other pharmacy services 

•Flu immunizations, diabetes, and wellness services

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Adult Immunization Recommendations

U.S. Vaccination Rates

https://www.vaccinefactsandpolicy.org/

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Opportunities

• Adult Vaccinations• Pneumo

• Zoster

• Tdap

• Adolescent Vaccines• Meningitis

• HPV

• Travel Health

Increase in International Travel

•In 2014 more than 68.2 million US residents traveled to international destinations.

•Mexico 25.9 million

•Canada 11.5 million

•Other overseas travel 30.8 million•Top sites include: UK, France, Italy, Germany, Spain, China, India, Philippines, Jamaica, Japan

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http://travel.trade.gov/outreachpages/outbound.general_information.outbound_overview.html

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• More people are exposed to rare or exotic diseases

• “The specialty of travel medicine has evolved rapidly as a result of 

the massive increase in international travel and tourism.”

• “…an increasing number of travelers will face the risks of exposure 

to many infectious diseases across the various geographic regions 

of the world.”113

Reference: 1: Jong EC, Zuckerman JN. Travelers Vaccines. Hamilton, Ontario: BC Decker Inc; 2004: v.

Increase in International Travel

Infectious Diseases of Concern to Travelers

• Diphtheria• Tetanus• Polio 

• Hepatitis A• Hepatitis B• Measles

• Mumps• Rubella• Varicella

• Malaria• Influenza• Meningitis• Yellow fever

• Japanese encephalitis

• Travelers’ diarrhea

• Typhoid

• Parasitic diseases

• Pneumococcal disease

• Rabies

• Cholera

• Dengue fever

• HIV/AIDS

• Many others…

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The CDC Advises…

“International travelers should contact health‐care providers who provide pre‐travel health advice at least 4‐6 weeks before departure for current health information and to obtain vaccinations and prophylactic medications.”1

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Reference: 1. Centers for Disease Control and Prevention. Health Information for International Travel 2005-2006. Atlanta, Ga: US Department of Health and Human Services, Public Health Service. 2005

2003 Kennedy International Airport Study1

•Latin America and Asia were the most common destinations

• Only…

•36% of travelers sought travel health advice

•17% of travelers considered themselves at risk for Hep A

•73% were going to areas where malaria was a high risk

• Only 46% were carrying anti‐malarial medications

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Reference: 1. Hamer DH, Connor BA. Travel health knowledge, attitudes and practices among United States travelers. J Travel Med. 2004;11:23-26

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Continued

•74% of travelers believed that vaccinations were effective for prevention and 

yet few were vaccinated for their journey:

• 11% Tetanus

• 14% Hepatitis A

• 13% Hepatitis B

• 5% Yellow fever

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Reference: 1. Hamer DH, Connor BA. Travel health knowledge, attitudes and practices among United States travelers. J Travel Med. 2004;11:23-26

Continued

•Where travelers got advice

• 60% Primary Care Physicians

• 30% Family and Friends

• 19% Internet

• 12% Occ Med Specialists or Co. Doctors

• 10% Travel Medicine Specialists

•Trip planning

• 53%  4+ Weeks

• 19%  2‐4 Weeks

• 15%  1‐2 Weeks

• 13%  1 Week

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Reference: 1. Hamer DH, Connor BA. Travel health knowledge, attitudes and practices among United States travelers. J Travel Med. 2004;11:23-26

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Developing Your Business Plan

What Can I Charge For?

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Consultations

PrescriptionsAncillary Supplies

Immunizations

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Immunization Business Plan Considerations

• Competitive analysis

• Financial modeling

• Patient forecasting

• Developing: policies, procedures  and protocols

• Training resources

• Vaccine purchasing 

• Vaccine inventory, storage, and shelf‐life

• Marketing your clinic

• Licensing and regulatory requirements

• Pre‐trip consultation software

• Rollout timeline and checklist

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Competitive Analysis

Proposed Locations

Certified Yellow Fever

Vaccination Sites1

Austin 12Houston 60San Antonio 12Total 84

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Reference: 1. CDC. Yellow Fever Locator. http://www2.ncid.cdc.gov/travel/yellowfever/l.

Accessed February 6, 2008.

• Yellow fever certified…does that make them a travel clinic?

• A rising tide lifts all boats!

For Illustration Purposes Only

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Financials

Proposed Locations International Travelers1

Austin 120,592 Houston 663,256 San Antonio 90,444 Total 874,292

Assumption: Capture 1% of Total 8,743

Assumption: Year 1- 25% of 1% 2186Total Patients Per Week 42 Patients Per City Per Week 14

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Reference: 1. ITA Office of Travel & Tourism Industries. 2006 Profile of U.S. Resident Travelers Visiting Overseas Destinations Raw Data Telephone Contact.

For Illustration Purposes Only

Financials

ExampleTravel Health Revenue Model

Billing Typically, Fee For Service Payment Cash, Check, or Credit CardCharges Vaccine Cost (50 -100% Mark Up)Consultation Fee $25 - $100

Directions:Tab through model, fill in green areas

What is Your Annual Patient Population? 874,292 % of Your Patients Traveling Internationally? 0.250%Travel Patients Per Year 2,186 Travel Patients Per Week 42.0

The average # of Travel Immunizations Per Patient Is: 3 Average Revenue Per Immunization? $85Consultation Fee Per Patient? $40Revenue Per Traveler $295Total Revenue Per Year $644,790

Consultation Minutes Spent With Patient? 20Revenue Per Hour $885

For Illustrative Purpose Only:Please be advised that some vaccines in this business model may be reimbursed by health plans, please see the individual patient's health plan for details.

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For Illustration Purposes Only

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•Exotic Vaccine Inventory

• 24‐48 hr Delivery 

• Under $400

•Initial Continuing Education Training 

Recommended

• $0

•Additional Immunization Supplies Based on 

Patient Volumea

• $0

•Refrigerator 

• $0

• Marketing Budget 

• $0 ‐ CDC Yellow Fever Clinic Locator

• ~$2,000,  6‐Month Referral Postcard 

Campaign

• $0‐$100 ‐ Social Media

• Join International Society of Travel 

Medicine

• $90‐$150 

• Online Consultation Software Service, 

Trial Subscription

• $0

25a Assumption: Pilot Sites currently Offering Routine Adult Immunizations

For Illustration Purposes Only

Financials: Initial Startup Budget ~$2,500

What Are Travel Immunizations?

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Recommended US Adult and Adolescent Immunizations1

• Influenza • Pneumococcal• Hepatitis A• Diphtheria, Tetanus, and Acellular

Pertussis• Meningococcal • Hepatitis B • HPV (Human Papillomavirus Vaccine) • Measles, Mumps, Rubella• Varicella• Zoster• Inactivated Polio

Travel Specific Immunizations

• Typhoid Fever • Yellow Fever • Japanese Encephalitis• Rabies • Inactivated Polio• Cholera

Required vs. Recommended Immunizations?

All the vaccines listed on this slide can be considered travel immunizations.

Reference: 1. Centers For Disease Control and Prevention. Advisory Committee on Immunizations Practices. http://www.cdc.gov/vaccines/recs/ACIP/default.htm. Accessed January 23, 2008.

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Travel Prescriptions1

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•Antibiotics•Ciprofloxacin •Norflaxacin •Oflaxacinn •Levofloxacin •Azithromycin •Rifaximin •Tinidazole** •Amoxicillin/Augmentin®

•Clarithromycin •Penicillin VK •Tetracycline or Doxycycline

•Altitude Sickness•Acetazolamide (Diamox)

•Dexamethasone (Decadron®)

•Meclizine

•Anti-malarials*•Chloroquine (Aralen®)

•Mefloquine (Lariam®)

•Atovaquone/Proguanil (Malaron®)

•Doxycycline (Vibramycin®)

•Primaquine

•Miscellaneous•Sleep Aids•Pain Relievers•Routine Prescriptions (Patient Specific)

Reference: 1. Shoreland, Inc. Clinic Operations, Vaccines and Medicines. https://www.travax.com/scripts/main/topframeset.asp?DocID=clinic. Accessed January 23, 2008.

Ancillary Products

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• Sunscreens and lipscreens

• Insect repellent (Deet)

• Maps

• Hand cleansers

• Trip-Size toiletries

• Travel pillows

• Compression hose

• Travel journals

• Luggage tags

• Travel games

• Folding canes

• Protective clothing

• Anti-diarrheas

• Travel health handbooks or first aid guides

• Emergency first aid kit

• Digital thermometer

• Water filters

• Water purification tablets

• Tincture of iodine

• Motion sickness treatment

• Dramamine® and Bonine®

• Oral rehydration and salts packets

• Potable Aqua® tablets

• Tincture of iodine

• Topical nasal sprays

Reference: 1. Shoreland, Inc. Clinic Operations, Patient Education. https://www.travax.com/scripts/main/topframeset.asp?DocID=clinic. Accessed January 23, 2008.

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Training

• Travel Continuing Education

• Various CE programs available

• Travel Resources

• http://apps.who.int/ithmap/

• https://wwwnc.cdc.gov/travel/

• https://wwwnc.cdc.gov/travel/destinations/list

• Travel Specific Software

•www.travax.com

•www.tropimed.com29

CDC Website

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Marketing

•Social Media

•Website/Blog

• In‐Store Signage

•Post Card Marketing campaigns

•Physician Communication

•Churches, Schools, Travel Agents

•Referrals

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IMMUNIZATION MARKETING CALENDAR

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Website

Website

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Website

Website

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Website

Blogs

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Store Signage

Initial Setup

• Identify a person, or a team of people, to implement your travel health business plan

• Work out a detailed 10‐week roll‐out plan to stay on track

• Your first week you should focus on the following:

• Research your state’s immunization rules and regulations 

• Establish immunization health policies, procedures, and protocols

• Review online consultation software services Immunization Recommendations

Travel Advisory (eg, crime) 

Consular Information

Basic Precautions (eg, insects, food and water, pre‐travel checklist

• Apply for a yellow fever stamp with your state health department1

• Identify a medical director or partnering physician

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Reference: 1. Centers for Disease Control and Prevention. Travel Clinics State health departments websites. http://wwwn.cdc.gov/travel/contentTravelClinics.aspx. Accessed January 23, 2008.

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Example: Startup Timeline

Week 1

• Apply for yellow fever certification with your state health department

• Request international certificate of vaccination (ICV) cards 

• Review travel health consultation software packages

• Join the International Society of Travel Medicine (ISTM) (optional)

Week 2

• Travel vaccine and disease training

• Vaccine procurement

• Various Wholesalers

• Vaccine specific vendors

• www.vaxserve.com

• Identify a local infectious disease physician if you need to refer your patient for post travel care or for complicated pre‐travel consults 

that may be beyond your scope of expertise

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Example: Startup Timeline

Week 3

• Review policies, procedures, and protocols

• Determine patient flow

• Establish fee structure

• Identify products other than vaccines: Prescriptions, OTC’s, ancillary 

Week 4

• Subscribe to travel consultation software that you evaluated in week one

• Create a consultation and immunization area

• Inside Marketing: Techniques for Your Own Customers

• Outside Marketing: Begin to assemble Referral Marketing Campaign

Week 5

• Begin to plan your grand opening event

• Host a travel health open house for referral sources such as local physicians

• Public relations

• Send your first wave of referral marketing postcards

• Hang posters and implement inside marketing materials

• Educate your staff  42

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Example: Startup Timeline

• Week 6

• Add travel health to your menu of services

• Get listed – be sure your travel health clinic is listed on the following Web search engines

https://wwwnc.cdc.gov/travel/diseases/yellow‐fever

State Department of Health Website

List on store website….improve SEO

• Week 7

• Throw open the doors of your travel health center

• Week 8

• Grand opening event

• Week 9

• Send your second wave of postcards – follow up mailings every five weeks

• Week 10

• Initial marketing review – continue to perform at three‐month interval  43

Patient Consult

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Initial Patient Contact

• Phone Triage• Ask Questions!!!!!

• Where are you going?

• When do you leave?

• How long is your stay?

• Are you current on your adult vaccinations?

• When was your last Tetanus shot?

• Who is your PCP?

Initial Preparation

• Set appointment• Make sure to leave plenty of time for vaccines needing multiple doses

• Research destination recommendations• Online travel software

• www.cdc.gov

• Contact PCP for RXs, if required by state law• Don’t forget malaria prevention, if needed

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Print Patient Traveler’s Reports

• www.travax.com

• Order vaccines• Allow 24‐48 hours

Traveler’s Reports

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Patient Arrival

• Intake Forms/Consent forms• Can email these to patient in advance

• New online technology options  

• Vaccine Information Statements

• Yellow Fever Certification, if needed

Basic Intake Form

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Travel Intake Form

Patient Consent Form

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Vaccine Informationstatement

CDC Form 731

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Patient Counseling

• Review Travel Health Report• Vaccine preventable diseases

• Safe food and water consumption

• Malaria prevention

• Crime or travel advisories

• Discuss vaccine options• Required versus Recommended

Patient Counseling (Continued)

• Administer appropriate vaccines

• Monitor for adverse reactions

• Document• Patient records

• Lot numbers

• Expiration dates

• Physician records

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Physician Letter

Patient Exit

• Give additional travel tools• Travel checklists

• Refer to your Ancillary Travel Products!

• Travel Health Tip Booklets

• Language barrier pointer cards

• Ask for a postcard!

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Travel Checklist

Conclusion

• Preventive Health

• Positive revenue for your practice

• Become a health care destination!• Resource for other Health Care Professionals

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Justin Wilson, Pharm.D

oupharm@mac.com 

Questions and technology demo to immediately follow CE portion of the presentation