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BACKGROUND Despite the availability of free and accessible influenza vaccine to all Ontarians, uptake has remained suboptimal. Although reasons to not receive the vaccine vary widely, health care provider recommendations remain the most effective strategy to positively influence vaccination decisions. OBJECTIVES This study aimed to predict the relative quality of life, costs, and cost-effectiveness of introducing a remunerated community pharmacist consultation service on influenza vaccination for Ontarians aged ≥ 65 years. METHODS A cost-utility analysis was performed from a third-party public payer perspective over 1 year. The delivery of consultation services by community pharmacists on influenza vaccination, billable at CAD $15 was compared with current standard practices (absence of remunerated consultations). Model inputs were derived primarily from existing literature. The impact of parameter uncertainties was assessed through deterministic and probabilistic sensitivity analyses. RESULTS The provision of influenza vaccine consultation services was predicted to prevent 2407 cases of mild influenza and 3 influenza-related deaths at an additional cost of CAD $2.03 per person over current practices. The incremental costs per quality-adjusted life-year (QALY) gained for the enhanced care strategy compared with standard care was CAD $2087. The interpretation of the base-case result was found to be robust across all sensitivity analyses. The projected additional costs of implementing pharmacist consultations in Ontario was estimated at CAD $1.15 million per year, and the anticipated benefits included a gain of 507 QALY per year. CONCLUSION Pharmacist-delivered consultation services on influenza vaccination are cost-effective and lead to improved clinical outcomes for Ontario seniors. Introduction of such services offers a promising strategy to address challenges related to poor vaccine uptake in this group.