Vaxi Taxi—The Uber Eats of Pharmacy—Serves Iowa’s Most Vulnerable

Casey Villhauer, PharmD, describes Iowa-based Vaxi Taxi, the business she launched in July 2020, as the Uber Eats of pharmacy.

Patients place an online order with Vaxi Taxi for a vaccine that they would like to receive at home or at work. Vaxi Taxi pharmacists review the request, consult with the patient, and send the request to the nearest affiliated independent pharmacy. The pharmacist, whom Vaxi Taxi has trained to deliver and administer vaccines at patient-preferred locations, prepares the vaccine and takes it to the patient’s home or car. Vaxi Taxi, which provides all the equipment, supplies, and software support needed to provide patient care for vaccination, collects a fee for each vaccine delivery.

“It’s essentially a hybrid of home health care and [community] pharmacy roles, and that’s not a space that pharmacists have typically ventured into because it’s not reimbursed well or at all,” Villhauer said.

But COVID-19 changed that.

Prior to availability of COVID-19 vaccines, Vaxi Taxi administered flu shots. Its primary patients were needle-phobic children whose parents were willing to pay a surcharge for vaccines to be administered in their own homes.

When FDA granted Emergency Use Authorization of COVID-19 vaccines, Vaxi Taxi had to make a hairpin turn, shifting its focus from concierge service to provider of vaccinations to some of the state’s most vulnerable patients. The pandemic brought an astronomical demand for administration of COVID-19 vaccines in patients’ homes and, for the first time ever, Medicare Part B was willing to pay pharmacists for some of those at-home administration fees.

“The patients that they paid the delivery fee for are the ones who have typically fallen behind on vaccines because they didn’t have anyone to bring them shots,” Villhauer said. “Individuals paying cash for home delivery of flu shots are a very different population from people struggling to get COVID-19 vaccines at home.”

Local and state governments partnered with Vaxi Taxi to help deliver COVID-19 vaccines to homebound patients. “We had to learn on the fly,” she said. Both the complexity of the fragile patient population and the intricacy of handling COVID-19 vaccines provided new challenges for the fledgling pharmacy business, but it was successful undertaking the endeavor.

The first COVID-19 vaccine that Villhauer administered through Vaxi Taxi was for a patient in rural central Iowa, who otherwise would have had to ride in an ambulance to be vaccinated at a hospital. Being homebound doesn’t exclude patients from needing protection against COVID-19.

“Homebound people have a lot of helpers coming in,” Villhauer said. “Those aides have a lot of contact with the public, and these patients tend to be the most medically vulnerable.”

The extent to which homebound patients are underserved is nearly impossible to measure. Medicare can tally the number of patients who receive home health services, but homebound people who get their day-to-day care from family members fly largely under the radar.

Today, more than a year after the vaccine rollout began, Vaxi Taxi has a team of 25 immunizers who have administered thousands of COVID-19 vaccines.

For Villhauer, working with the homebound population has been bittersweet given that Medicare only covers at-home administration for COVID-19 vaccines. “It feels great to bring COVID-19 vaccines to these patients who can’t get it any other way, but…I can’t bring them pneumonia vaccines or shingles vaccines.”

Villhauer hopes that the pandemic will shine a light on the ongoing needs of homebound patients and that federal provider status will one day allow pharmacists to better address those needs.

—Sonya Collins
April 2022

Resources to Tailor Your Outreach and Answer Common Questions about COVID-19 vaccine are available at APhA’s Vaccine Confident microsite.