title: Pharmacist authority to provide HPV vaccine: novel partners in cervical cancer prevention.
abstract: OBJECTIVE
  While the provision of cervical cancer prevention services in the United States has expanded to new settings beyond clinics that give Pap smears, prevention efforts are being hampered by relatively low human papillomavirus (HPV) vaccine coverage. Pharmacies are an underused setting to deliver HPV vaccine. To better understand this opportunity, we sought to classify pharmacists' authority to administer HPV vaccine in each US state.
  
  
  METHODS
  For each US state and the District of Columbia (for simplicity, we refer to these 51 regions as states), we interviewed a member of the state's pharmacy association, member of the state board of pharmacy, or a faculty member at a school or college of pharmacy.
  
  
  RESULTS
  Most states (80%) allowed pharmacists to provide HPV vaccine to adult women ages 19 and older, and 61% of states allowed provision to girls age 12. The mechanism for pharmacists to immunize was highly variable across states. For example, a 12 year-old girl seeking HPV vaccine could receive it from a pharmacist in 31% of states under a protocol between a specific physician and pharmacist, in 24% with an HPV vaccine prescription, and in 6% without prior physician approval. Pharmacists' authority was broadest on the west coast and limited on the east coast. Pharmacist authority to provide HPV, Tdap, and meningitis vaccines was very similar, but it was highly dependent on patient age.
  
  
  CONCLUSIONS
  US states' laws governing pharmacists' ability to offer HPV vaccine varied widely. One consequence is that newly expanded cervical prevention efforts underuse pharmacists.
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Campus Box 7440, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514, USA.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
authors.affiliation: Eshelman School of Pharmacy, University of North Carolina, Pharmacy Lane, Chapel Hill, NC 27599, USA.
authors.forename: Jake K
authors.initials: JK
authors.lastname: Chung
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Campus Box 7435, Chapel Hill, NC 27599, USA.
authors.forename: Hannah M
authors.initials: HM
authors.lastname: Baker
authors.affiliation: American Pharmacists Association, 2215 Constitution Ave, NW, Washington, DC 20037, USA.
authors.forename: Mitchel C
authors.initials: MC
authors.lastname: Rothholz
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Campus Box 7435, Chapel Hill, NC 27599, USA. Electronic address: JenniferS@unc.edu.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D005260:Female; D006801:Humans; D007885:Legislation, Pharmacy; D027383:Papillomaviridae / Q000276:immunology; D030361:Papillomavirus Infections / Q000517:prevention & control* / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010595:Pharmacists / Q000331:legislation & jurisprudence*; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology
chemical_list: D053918:Papillomavirus Vaccines
keywords: HPV; Meningococcal; Pharmacist; Tdap; Vaccine policy