AAP: Pharmacists Must Band Together and Advocate for a Seat at the Table

The American Society of Health-System Pharmacists (ASHP) is launching PharmTech Ready, a training program that will help bridge the professional development and training gaps that are among the drivers of the current nationwide shortage of pharmacy technicians, the organization said in a statement.

“The growing shortage of pharmacy technicians poses a significant challenge to achieving optimal medication outcomes and protecting patient safety,” said Paul W. Abramowitz, PharmD, FASHP, CEO of ASHP. 

“PharmTech Ready draws on ASHP’s extensive experience in developing education and practice resources for the pharmacy workforce and will help technicians build the skills needed to fulfill their essential role on the healthcare team,” Abramowitz added.

A majority of hospital and health-system pharmacy administrators reported turnover rates between 21% and 30% in 2021; nearly 1 in 10 had lost 41% or more of their technicians, according to a recent ASHP survey.

In addition, the survey found that a growing number of health systems are responding to technician requests for professional development by implementing internal training programs.

PharmTech Ready provides healthcare organizations with tools to develop internal training programs to strengthen their ability to recruit, retain, and advance the pharmacy technician workforce, ASHP said.

The program aligns with the didactic learning requirements of the ASHP/Accreditation Council for Pharmacy Education (ACPE) Model Curriculum. It features over 160 hours of entry- and advanced-level content on more than 70 topics and includes supplemental materials that will allow healthcare organizations to leverage their sites for experiential training.

PharmTech Ready also includes access to a range of exclusive ASHP continuing education, tools, and other resources to “bolster pharmacy technicians’ professional development and support their career advancement as critical members of the healthcare team,” ASHP said.

1. ASHP launches pharmacy technician training program to address workforce shortages. News release. American Society of Health-System Pharmacists. May 3, 2022. Accessed May 19, 2022. 

https://www.ashp.org/news/2022/05/03/ashp-launches-pharmacy-technician-training-program-to-address-workforce-shortages

2. Pharmacy technician shortage survey findings executive summary. American Society of Health-Systems Pharmacists. Published March 2022. Accessed May 19, 2022. 

https://www.ashp.org/-/media/assets/pharmacy-technician/docs/Technician-Shortage-Survey-Exec-Summary.pdf

Articles

The PharmTech Ready training program bridges professional development and training gaps.

New ASHP Training Program Aims to Help with Pharmacy Tech Shortage 

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

What's Going On with the Infant Formula Shortage

Parents are on edge as the formula shortage worsens across the United States. Pediatricians, the AAP, and White House advise on available options.

FDA Authorizes Non-Prescription At-Home Test for COVID-19, Flu, and RSV

The test will be available direct to consumers without a prescription.

Data from one study showed younger women more likely to use sunscreen than older adults.

More Than 100,000 US Deaths Prevented by Pfizer-BioNTech Vaccine in 2021

The vaccine also prevented nearly 9 million symptomatic cases.

Bimekizumab Fails to Pass FDA Pre-Approval Inspection

UCB announced the FDA issued a CRL that stated that the FDA cannot approve the BLA in its current form.

Your weekly roundup of the latest news from Drug Topics®.

News Roundup: May 16 to May 20

Although several pharmacy groups praised the Centers for Medicare and Medicaid Services (CMS) final rule on retroactive direct and indirect remuneration (DIR) fees, they are concerned about the delay in implementation and other issues.

CMS’s final rule, Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs

 late last month. The rule’s provisions affecting DIR fees will take effect January 1, 2024.

Delaying implementation until 2024 is a missed opportunity for patients and pharmacies, according to the American Pharmacists Associaton (APhA), the National Community Pharmacists Association (NCPA), and other organizations.

“We’re disappointed that PBMs and their insurer-partners/owners have been given another year to manipulate the system and continue charging higher costs to seniors,” said NCPA CEO B. Douglas Hoey, R.Ph., in a news release.

“Further, the final rule does not prohibit [pharmacy benefit manager] contract terms that allow for penalty payments after prescriptions leave the pharmacy; therefore, retroactive penalties could still occur. CMS must close this loophole to accomplish the meaningful pharmacy DIR reform that so many of us have been fighting for,” Hoey added.

APhA praised the passage of the final rule and elimination of a proposed loophole “that would have left it up to the Part D plans and PBMs to determine how much, if any, of the pharmacy price concessions they would pass through to patients at the point of sale during the coverage gap in the Medicare Part D program,” APhA said in a news release.

However, CMS’s final rule “merely moves the fees to the point-of-sale negotiated price. It does not eliminate these fees,” APhA said.

“Eliminating the retroactive use of DIR fees is a step in the right direction, but it’s only the tip of the iceberg to end PBMs’ business practices that are harmful to patients and hurt our nation’s pharmacies,” said Scott J. Knoer, MS, PharmD, executive vice president and CEO of APhA.

NACDS President and CEO Steven C. Anderson commended CMS for “initiating long-overdue reform of these dire DIR fees in a way that will benefit seniors.”

“We appreciate that CMS finalized this rule, and improved the proposed rule according to some of NACDS’ recommendations…CMS took action to address transparency for all components of Medicare – including prescriptions filled for patients in the ‘coverage gap,’” Anderson said.

However, “It is vital for additional regulatory guardrails to be put into place and to prevent any unintended consequences that could harm patients and pharmacies alike,” Anderson noted.

“It is critically important that there be no further delays. Further, NACDS calls on Congress and on CMS to accomplish swiftly the additional comprehensive reforms that are essential for pharmacy viability and for patient access. The pro-patient and pro-pharmacy work that remains includes the establishment of standardized pharmacy quality measures, which merits an immediate legislative remedy,” Anderson added.

Leslie G. Sarasin, president and CEO of FMI-The Food Industry Association, also praised CMS but raised similar concerns as the other association executives.

 “FMI is pleased CMS has heard our long-held concerns about predatory PBM practices like retroactive DIR fees and determined that regulatory action is desperately needed to reduce drug costs for patients and to provide greater certainty for pharmacies so that they can remain in business and continue serving their customers,” Sarasin said in a news release.

 “However, even as we applaud these important reforms, we also believe the Biden administration missed an opportunity to provide swift relief to consumers and pharmacies alike by delaying the implementation of this rule until 2024.”

Despite their essential role in serving communities, particularly during the last 2 years amid the pandemic, supermarket pharmacies have struggled to stay in business or grow their pharmacy operations, especially in underserved areas, due to the anticompetitive practices of PBMs, Sarasin said.

In fact, some FMI members have been forced to close or sell their pharmacies due to “exorbitant” DIR fees, leading to significantly reduced access for consumers, according to Sarasin.

1. Final rule: Medicare program; Contract year 2023 policy and technical changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs. CMS. Published April 29, 2022. Accessed May 19, 2022. 

https://public-inspection.federalregister.gov/2022-09375.pdf

2. NCPA: Final rule improves transparency; protections for patients and pharmaciesstill needed. News release. National Community Pharmacy Association. May 2, 2022. Accessed May 19, 2022. 

https://ncpa.org/newsroom/news-releases/2022/05/02/ncpa-final-rule-improves-transparency-protections-patients-and

3. APhA appreciates CMS’ elimination of retroactive DIR fees. News release. American Pharmacists Association. May 2, 2022. Accessed May 19, 2022. 

https://pharmacist.com/APhA-Press-Releases/apha-appreciates-cms-elimination-of-retroactive-dir-fees

4. With DIR feetransparency rulefinalized, NACDS urgescontinued push for comprehensive reform. News release. National Association of Chain Drug Stores.May 2, 2022. Accessed May 19, 2022. 

https://www.nacds.org/news/with-dir-fee-transparency-rule-finalized-nacds-urges-continued-push-for-comprehensive-reform/

5. FMI welcomes pharmacy DIR regulatory reforms to reduce drug costs and increase transparency, despite implementation delay. News release. FMI-The Food Industry Association. May 1, 2022. Accessed May19, 2022. 

https://www.fmi.org/newsroom/latest-news/view/2022/05/01/fmi-welcomes-pharmacy-dir-regulatory-reforms-to-reduce-drug-costs-and-increase-price-transparency-despite-implementation-delay

The rule will take effect January 1, 2024. 

Pharmacy Groups Praise Medicare DIR Fee Reform, But Have Concerns 

On May 17, Democrats from the United States House of Representatives proposed a $28 million funding bill to address the nationwide infant formula shortage. The bill would give the Food and Drug administration (FDA) access to the funds to increase staff in charge of formula inspection before the product is sent to suppliers and also help prepare for future shortages.

When asked about fund delegation within the FDA at a press conference announcing the proposed legislation, Representative Rosa DeLauro, Democrat of Connecticut, and chairwoman of the Appropriations Committee, said “What this does is divide [funds] up into formula supply chain monitoring and assessment for a million and a half dollars. Health fraud, state partnerships, laboratory methods, development, $3 million to the Office of Regulatory Affairs, social media data capture, analysis to identify unsafe infant formulas so we can track stuff online and [that is] half a million dollars. Then, it’s in infant formula and staffing, it’s $23 million.”

Speaker of the House Nancy Pelosi of California addressed that while the Biden Administration has been monitoring the situation and putting steps into place to help lessen the shortage, more action is now needed. She also highlighted the unsafe importation of non-FDA regulated infant formula.

“The Biden Administration has been taking action since February. [The administration] provided more flexibility for the [Women, infants, and Children] program to boost accessibility, they worked with manufacturing to increase production and encourage importation of safe formula. I think the bottom line is they have been taking action, but we really feel that now more needs to be done,” Pelosi said, in the press conference. “One of the things that bothers me is that I found out in the last couple of days that people are now ordering, I guess through the mail, formula from Canada and other countries.” On May 18, President Joe Biden also invoked the Defense Production Act to aid in the baby formula shortage. The act allows the federal government to push businesses to prioritize production and delivery of certain goods and supplies during a dire nationwide shortage.

While the FDA’s announcement of infant formula importation flexibility from usually unutilized foreign countries will increase access, according to Pelosi, she expects that the newly proposed bill will help speed up FDA inspection process of those imported products, making them hit the shelves faster.

The legislation is expected to reach the House floor this week.

This article originally appeared on Contemporary Pediatrics.

Infant Formula Supplemental Appropriations Act, 2022. United States House of Representatives. Published May 17, 2022. May 18, 2022. 

https://appropriations.house.gov/sites/democrats.appropriations.house.gov/files/FY22FORM_Supplemental_xml.pdf

Transcript of Pelosi remarks at press conference on legislation to address baby formula shortage. Nancy Pelosi Speaker of the House. Published May 17, 2022. Accessed May 18, 2022. 

House democrats release $28 million aid bill to address formula shortage. The New York Times. Published May 17, 2022. Accessed May 18, 2022. 

https://www.nytimes.com/2022/05/17/us/politics/baby-formula-shortage-house-bill.html

The proposed aid bill would give the FDA funds to increase staff and prepare for future infant formula shortages.

$28 Million Aid Bill for Formula Shortage Proposed in Congress

Data from a systematic review and meta-analysis of randomized clinical trials with tirzepatide describe the safety and efficacy of the novel dual glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist in the management of type 2 diabetes.

Leveraging data from 7 clinical trials with more than 6500 participants, results of the study provide an overview of the HbA1c lowering, incidence of hypoglycemia, and risk of discontinuation seen with various doses of tirzepatide compared against placebo therapy, basal insulins, and GLP-1 receptor agonists.

“Our meta-analysis findings can help clinicians and other diabetes stakeholders to determine the optimal place of tirzepatide among existing medications for type 2 diabetes,” wrote investigators. “We found that tirzepatide is superior in reducing HbA1c compared with other injectable therapies, in particular basal insulin and once-weekly GLP-1 RAs. In addition, tirzepatide, even at the lowest maintenance dose of 5 mg, can reduce body weight to a greater extent compared with GLP-1 RAs including subcutaneous semaglutide which, in turn, has been shown to be superior to other glucose-lowering agents.”

Approved by the US Food and Drug Administration on May 13

 for improving glycemic control in patients with type 2 diabetes, tirzepatide (Mounjaro) is being welcomed as monumental moment in the landscape of diabetes care. A first-in-class agent approved based on the SURPASS trials, with additional data backing use in obesity, endocrinologists, diabetologists, and primary care providers alike have been captivated by the agent’s potential in multiple disease states.

Spurred by Eli Lilly and Company’s announcement of their new drug application to the FDA in fall of 2021, the current systematic review and meta-analysis was designed by a team of investigators from the Aristotle University of Thessaloniki in Greece, led by Thomas Karagiannis, PhD, MSc, with the intent of providing clinicians with synthesized data from available randomized controlled trials of tirzepatide. From a search of the PubMed, Embase, Cochrane and ClinicalTrials.gov from inception through October 27, 2021 for randomized controlled trials with a duration of at least 12 weeks, investigators identified 7 trials for inclusion in their study.

The 7 trials identified for inclusion were SURPASS 1-5, a double-blind phase 2 trial comparing tirzepatide in 5, 10, and 15 mg doses to placebo or dulaglutide 1.5 mg in patients with type 2 diabetes who were drug-naive or on metformin monotherapy, and a double-blind phase 2 trial comparing tirzepatide 15 mg against placebo in patients with type 2 diabetes who were drug-naive or on metformin monotherapy. Investigator noted all studies had a parallel-group design and 3 were open-label. The duration of interventions in the trials ranged from 12-52 weeks.

From these trials, investigators obtained data related to a cohort of 6609 participants for inclusion in their analyses. At baseline, the mean age of this cohort was 58 years, the mean body weight was 91.5 kg, and the mean HbA1c was 8.2%. The primary outcome of interest for the investigators’ current analyses were the change in HbA2c from baseline. Secondary outcomes of interest included change in body weight and safety outcomes.

Results demonstrated a dose-dependent superiority for lowing HbA1c was observed with the 5, 10, and 15 mg doses of tirzepatide against all comparators, with mean differences ranging from -1.62% to -2.06% against placebo, -0.29% to -0.92% against GLP-1 receptor agonists, and -0.70% to -1.09% against basal insulin regimens. Similarly, superior reductions in bodyweight were observed with tirzepatide against all comparators, with investigators highlighting reductions versus GLP-1 receptor agonists ranging from 1.68 kg with tirzepatide 5 mg to 7.16 kg with tirzepatide 15 mg.

When assessing the safety of tirzepatide, results indicated the incidence of hypoglycemia observed with tirzepatide was similar to the incidence rate observed with placebo therapy and lower than rates observed with basal insulin. Investigators pointed out nausea was more frequent with tirzepatide than placebo therapy, especially with tirzepatide 15 mg (OR, 5.60 [95% CI, 3.12 to 10.06]). Tirzepatide 15 mg was also associated with increased incidence of vomiting (OR, 5.50 [95% CI, 2.40 to 12.59]) and diarrhea (OR, 3.31 [95% CI, 1.40 to 7.85]). Investigators also pointed out tirzepatide 15 mg was associated with a higher discontinuation rate due to adverse events regardless of comparator, but all tirzepatide doses were considered safe in terms of serious adverse events and mortality.

“The findings of this meta-analysis of seven RCTs suggest a dose-dependent superiority of all three tirzepatide maintenance doses on glycemic control, not only vs placebo but also vs long-acting GLP-1 RAs and basal insulin regimens. All tirzepatide doses were superior to all comparators in terms of reducing body weight,” wrote investigators.

This article was originally published by Endocrinology Network.

Karagiannis T, Avegerinos I, Liakos A, et al. Management of type 2 diabetes with the dual GIP/GLP-1 receptor agonist tirzepatide: a systematic review and meta-analysis. 

. 2022 May 17;1-11. doi: 10.1007/s00125-022-05715-4. Online ahead of print.

A systematic review and meta-analysis of 7 trials provide a detailed overview of the reductions in HbA1c and body weight, as well as the safety, of tirzepatide in various doses compared against placebo and other diabetes medications from clinical trials.

Efficacy, Safety of Tirzepatide in Type 2 Diabetes Examined in Review

Effective management of frequently debilitating itch starts with understanding type.Matthew J. Zirwas, MD, offered tips for diagnosing and treating widespread itch with little to no rash as part of his presentation at the recent New Wave Dermatology Conference.1

“Itch is an interesting space,” Zirwas told Dermatology Times®. “It gets more and more complicated the more we know about the mechanism but simpler and simpler in terms of managing itch. There are some really helpful things that most people in dermatology just aren’t aware of that I love teaching about.”

Zirwas, an associate professor at Ohio University Heritage College of Medicine in Athens, Ohio, covered new research on itch and practical recommendations for translating that to patient care.What followsare his tips for addressing the unique characteristics of widespread itch that does not present with an obvious rash.

Zirwas noted there is “no identifiable cause in the vast majority of [these] cases.” When there is, “it is usually a diagnosis that predated the start of the itch. It is in the medical history, not something you’re going to diagnose because of the itch.”

For cases with itch that “is all over, all the time,” he advised first “considering and usually ordering” these tests: complete blood count, comprehensive medical panel, thyrotropinhemoglobin, and hemoglobin A1c. “If merited by the individual case, I would consider, but rarely order, hepatitis B and C, HIV, , and a chest x-ray.”

However, in some patients with persistent, widespread itch, it may be necessary to weigh whether to test for cancer, he added. “The only overrepresented [types] are bile duct malignancy and hematologic malignancy,” he said, and both are typically going to be detected with routine labs (leukemia, hypereosinophilic syndrome, etc with a CBC) or exam (bile duct malignancy because of jaundice, as the itch starts after the bile duct is blocked, lymphoma via lymph node exam).“So, order age-appropriate malignancy screens, do a lymph node exam, conduct a complete review of symptoms, and work up any abnormals aggressively.” However, he cautioned, “Don’t go fishing if the review of systems, physical exam and basic labs are normal.”

Steroids remain a standard first-line treatment for widespread itch, although studies suggest that their role in itch reduction may be more attributable to their action in improving the skin disease overall by decreasing inflammation rather than by directly reducing itch.2

“If a systemic steroid doesn’t work, it suggests the itch is not immunologic/inflammatory,” Zirwas said. “If it does work, the itch could still be neuropathic as steroids work on everything.”

For generalized itch, Zirwas said it is “reasonable” to give patients a 3-week steroid taper to show improvement. “If they do [improve], find the minimum dose to relieve itch and use it chronically,” he said. A prednisone equivalent of 10mg should be prescribed every other day or less, he noted, , as at this dose (5 mg/d or less of prednisone) the risk of short or long term side effects from systemic steroids is quite low, even with long term use

Although he has both male and female patients who have responded to this dosing regimen for prednisone without major adverseeffects, it is not the right choice for every patient. “If prednisone works but the necessary dose it too high, something like methotrexate is worth a trial.” The starting point could be 5 mg to 10mg weekly, which, said Zirwas, “increases the activity of regulatory Tcells so it isn’t suppressing the immune system—it’s balancing it.”He finds low dose methotrexate particularly useful in elderly patients, in whom he suspecta the cause of itch is often unregulated, non-specific, sub-clinical inflammation related to an age related waning of Treg function.

Dexamethasone is another option. “I’ve found that 0.75 or 0.5mg can be used 10 days on and 4 days off. The 0.75 mg dose equals the anti-inflammatory efficacy of 25 mg of prednisone with the [adverse] effects of 5 mg,” Zirwas said.

This article was originally posted by Dermatology Times. 

Matthew Zirwas, MD, shares his step-by-step pearls for quelling the pruritic skin condition.

Simplifying Widespread Itch Care with Targeted Solutions 

“The opioid epidemic has raged on despite the development of evidence-based treatment for opioid use disorders,” explained Kimberly Hu, MD, at the 

2022 American Psychiatric Association Annual Meeting

. “About 70% of the nearly 71,000 drug overdose deaths in 8 states involved opioids. That's a huge, staggering number.”

Recognizing the role that insufficient access to medications plays in this epidemic, Hu and colleagues at the 

Ohio State University Wexner Medical Center

, designed and implemented an opioid use disorder (OUD) curriculum for third-year medical students. The students (n=405) were provided with in-person or virtual buprenorphine waiver training and in-person clinical experiences between January 2019 and April 2021. Pre- and post-intervention tests,along with self-reported clinical management surveys,assessedthe students’ability to screen patients with OUD and manage acute and chronic pain. Paired sample t-tests were estimated to assess improvement in knowledge and approach to clinical management principles.

Hu, a resident at the Ohio State University Wexner Medical Center, and colleagues found a statistically significant increase in both their knowledge as seen in the pre- and post-test scores as well as their self-reported understanding of management principles. A follow-up study at the end of the year also provided positive feedback. Hu reported: “83% [of the participants] said that they felt they knew how to manage acute pain, about 62% felt that they knew how to manage chronic pain, and about 77% said that they knew how to screen the patient for opioid use disorder.” This is important no matter which specialty the students pursue, as these students will be able to “link patients with resources early and make sure that there aren’t patients slipping through the cracks,” Hu explained.

She noted that educating third-year medical students gives them—and their future patients—an advantage. “They're a little over halfway through medical school, and then they'll go into residency in a number of different specialties. So giving them this knowledge early helps them to incorporate [the information and skills] as they continue their training.”

Hu noted that the educational program is ongoing and supported by the 

Substance Abuse and Mental Health Services Administration

. Her study co-authors included Julie Niedermier, MD; Amanda Start, PhD;Casia Horseman, MD; and Julie Teater, MD.

“If we can educate the next generation physicians and increase access to care, this is one way we can combat the opioid crisis,” Hu concluded.

This article originally appeared on Psychiatric Times.

New research presented at the 2022 American Psychiatric Association Annual Meeting evaluated program to help address the opioid epidemic.

Program Offers New Way to Fight Against Opioid Use Disorders

Among the many mysteries of the COVID-19 pandemic, one of the most confounding to the medical community is that of “long COVID,” which refers to patients whose symptoms persist months after their COVID infection.

While most patients who contract COVID-19 improve within weeks of infection and don’t become severely ill, estimates show that about a 

 of patients experience long COVID, with symptoms ranging from fatigue and shortness of breath to onset of new chronic conditions, such as hair loss, for many months after becoming infected. Some people with long COVID may 

Long-COVID has the potential to alter lives and can derail the health and plans of those affected by it. For that reason, long-COVID can be considered a 

 under the Americans with Disabilities Act (ADA) if it substantially limits one or more major life activities. That’s why it is crucial to both public health and welfare that the minimization of long COVID be considered a critical public health objective alongside reduction of the spread of COVID-19.

A study of vaccination and long COVID that we recently conducted offers some help in that regard. A quarter-million patients infected with COVID-19 were included in our analysis. We found found that vaccination prior to — or soon after — infection protects those who are infected with COVID-19 against the effects of long COVID.

Although vaccination soon after infection would run contrary to current CDC guidance, these findings suggest that earlier vaccination could lead to a decline in the number of patients suffering the effects of long COVID.

Before delving into the details of our study, it’s worth taking a deeper look at long COVID and exactly what the CDC advises for those seeking vaccination while experiencing COVID-19 symptoms.

Among the most insidious aspects of long COVID is that it can strike even the asymptomatic.

 , long COVID symptoms can surface in anyone who has contracted the disease, even if the person had only mild or no initial symptoms. Sufferers of long COVID report experiencing persistent symptoms ranging from fatigue and shortness of breath to brain fog, heart palpitations, pins-and-needles feelings, sleep problems, and changes in smell or taste.

The specificity of those symptoms belies the potentially far-reaching effects of long COVID, which has the potential to affect all of the body’s organ systems and may require prompt and sustained attention in more severe cases. Children can also experience long COVID, and the disease appears tod disproportionately affect women compared with men, according to the 

So far, it’s unclear why some patients who contract COVID continue to experience long COVID symptoms. Researchers are investigating this important question; studies to-date have been 

A new look at vaccinations for symptomatic patients

CDC guidelines updated as recently as December 2021 instruct people experiencing COVID-19 symptoms to avoid being vaccinated until symptoms disappear. Specifically, the CDC recommends providers “defer vaccination of people with known current SARS-CoV-2 infection until the person has recovered from acute illness (if the person has symptoms) and until criteria have been met for them to discontinue isolation.”

However, our analysis of COVID patients (in collaboration with the 

), found that unvaccinated patients who received their first COVID-19 vaccination within four weeks of infection were up to six times less likely to report multiple long COVID symptoms compared to those who remained unvaccinated.

We also discovered that those who received their first dose four-to-eight weeks after diagnosis were still three times less likely than those who remained unvaccinated to report multiple long COVID symptoms.

Our study suggests that COVID-19 vaccines may serve a therapeutic effect, potentially reducing the incidence of long COVID when administered to those currently infected, and that that protective effect is greater the earlier the vaccine is administered. If further studies on safety and efficacy of acute-phase COVID-19 vaccination bear out these results, significant public health benefits could be realized as fewer of the unvaccinated who become infected with COVID-19 experience long COVID.

While clinicians and researchers continue critical research into long COVID and COVID-19 more generally, it’s important to keep in mind patients continue to suffer each day from this debilitating and complex condition.

For those who are unvaccinated, this study adds yet another reason — protection against long COVID — to get vaccinated as soon as possible.

For those who find themselves infected, it offers hope that earlier vaccination, even while symptomatic, can help reduce the likelihood of developing long COVID.

This article originally appeared on Managed Healthcare Executive.

Research suggests that COVID-19 vaccination may serve a therapeutic effect, possibly reducing the risk of developing long COVID when administered to those currently infected.

Understanding What Vaccines Could Mean for Long COVID

Underserved and vulnerable communities do not have equitable access to care from COVID-19 Test to Treat sites, according to a new analysis

 from the American Pharmacists Association (APhA).

While there are more than 28,000 community pharmacies located in federally recognized underserved communities, only 700 Test to Treat sites have been established in those areas, according to APhA’s analysis. 

“Tapping the pharmacies in these areas could increase access to treatments by about 3900%,” APhA said.

Only 22% of Test to Treat sites are in the most vulnerable areas in the country as defined by the Social Vulnerability Index. And only 30% of sites are in medically underserved areas within the United States, APhA found.

“Although [the Department of Health & Human Services] has recognized the high level of training pharmacists receive by authorizingpharmacists to prescribe COVID-19 therapeutics, FDA’s emergency use authorizations for oral COVID-19 antivirals specifically exclude pharmacists as prescribers,” APhA said in a news release.

 As a result, the majority of pharmacies cannot serve as Test to Treat sites.

“These medications are being underutilized and sitting on pharmacy shelves, which unnecessarily increases health care costs and puts lives at risk,” APhA said.

APhA is calling on the federal government to include pharmacists as prescribers of oral COVID-19 antivirals to “significantly increase equitable access to Test to Treat pharmacies by opening the door to communities that need it the most.”

1. Inequity to COVID-19 Test to Treat access — Pharmacists can help if permitted. Report. American Pharmacists Association. Published May 17, 2022. Accessed May 18, 2022. 

https://www.pharmacist.com/Advocacy/Issues/Inequity-to-COVID-19-Test-to-Treat-Access-Pharmacists-can-help-if-permitted

2. Ninth amendment to declaration under the public readiness and emergency preparedness act for medical countermeasures against COVID-19. Federal Register. US Department of Health & Human Services. Published September 14. 2021. Accessed May 18. 2021. 

https://www.federalregister.gov/documents/2021/09/14/2021-19790/ninth-amendment-to-declaration-under-the-public-readiness-and-emergency-preparedness-act-for-medical

3. Inequity to COVID-19 Test to Treat Access — Pharmacists can help if permitted. News release. American Pharmacists Association. May 18, 2022. Accessed May 17, 2022.

Communities who are undeserved and vulnerable to COVID-19 were found to be not have much-needed access to test-to-treat location, according to an analysis by the American Pharmacists Association.

APhA: Underserved Communities Lack Access to Test to Treat Sites 

As pediatric health care providers, we are fully aware of the havoc that the sun can wreak, especially on unproteced skin. Protective measures such as sunscreen use help reduce the effects of the sun’s UV rays, especially on the delicate skin of children. Specific effects of UV radiation (UVR) include erythema, edema, darkening pigment, suppression of the immune system, and premature aging of the skin. UVR can damage DNA and interfere with normal cell function, leading to skin cancers.

The sun’s UV light is divided into UV-A, UV-B and UV-C. UV-A (320-400 nm) is not absorbed by the ozone layer. UV-A is believed to penetrate deeper into the skin, damage connective tissue, and lead to skin cancers, among other kinds of skin damage. UV-B (290-320 nm) is mostly absorbed by the ozone layer, but some does get through. It does not penetrate the skin as deeply, but the risk of triggering skin cancer is well established. UV-B is also responsible for burns. UV-C (100-290 nm) is absorbed by the ozone layer not thought to pose a skin cancer risk. Multiple factors affect how much UVR gets to the earth surface; unfortunately, ozone-depleting chemicals used in industry and consumer products have thinned the ozone layer.

Although UV-B can help the body synthesize vitamin D, most pediatric health care providers recommend using sun protection and taking a supplement of 400 IU of vitamin D3, if it is not consumed in the diet. The effects of UVR on the eyes have been associated with a number of disorders—some affect only adults, others also affect children—including macular degeneration, pterygium (a noncancerous growth that starts on the conjunctiva and can extend to the sclera and cornea), photokeratitis (temporary sunburn-like change that affects the cornea), keratopathy (disease that affects the cornea), and cortical cataracts.

The sun is the most intense on your skin between 10 am and 2 pm. However, for a patient’s eyes, the time of maximum UV exposure is from 8 to 10 am and from 2 to 4 pm, when the sun is parallel to the eyes. UV-B is absorbed mainly by the cornea, whereas UV-A is absorbed by the cornea, aqueous, and lens.

According to the American Academy of Ophthalmology, sunglasses should block 99% to 100% of both types of rays. A “UV 400 rating signifies the highest level of protection, blocking wavelengths up to 400 nm. Polarized sunglasses block glare but do not provide adequate UV protection. Ideally, sunglasses offer both UV 400 and polarization. Wearing sunglasses with side panels, which address oblique rays, is also recommended.

 Eye damage is from UVR is cumulative, not showing up until you are in your forties. Children are more at risk because they have larger pupils and more transparent ocular media.

Clinical study findings show that people get most of their sun exposure before 18 years of age. As with the eyes, sun damage to skin builds up, and consequences may not be seen for decades. Getting blistering sunburns and working outside in the sun for at least 3 years before age 18 years increases the chances of developing skin cancer later.

The type of exposure to UVR also affects risk of skin cancer. Chronic exposure refers to frequent, extended outdoor exposure; outdoor workers, swimming instructors, and camp counselors, for example, are more likely to develop squamous cell carcinoma. Those who get intermittent recreational exposure—from, say, spending extended time on the beach a few times a year—may be predisposed to basal cell carcinoma and melanoma. Burns may not be seen for 4 hours, worsen for 24 to 36 hours, and usually resolve in 3 to 5 days.

Other contributing factors to UV exposure include time of day, time of year, latitude, altitude, and weather conditions, as well as reflective surfaces such as snow, cement, water, and sand. A common misconception is that cloud cover protects against solar rays, but clouds scatter just 20% of UV light—80% gets through.

The US Food and Drug Administration (FDA) describes sunscreen’s active ingredients as chemicals that absorb, reflect, or scatter radiation in wavelengths ranging from 290 to 400 nm. Sunscreens are further divided into the organic type, which absorb UVR, and the physical type (including zinc oxide and titanium dioxide), which reflect or scatter UVR.

Sun protective factor (SPF) is a measure of how much UVR is required to produce a sunburn on protected skin relative to the amount required to produce a sunburn on unprotected skin. The higher the SPF, the greater the protection.

The FDA also categorizes OTC sunscreens based on their active ingredients. Those deemed generally recognized as safe and effective (GRASE) are products that contain zinc oxide and titanium dioxide. The second category contains non-GRASE ingredients such as p-aminobenzoic acid (PABA) and trolamine salicylate, which have been pulled off the market because of safety concerns. PABA can trigger contact allergy and photosensitivity.

 Trolamine salicylate safety and efficacy have not been established for children, and when used in sunscreen, this compound can trigger salicylate toxicity and serious bleeding.

Other non-GRASE active ingredients include avobenzone, cinoxate, dioxybenzone, ensulizole, homosalate, meradimate, octinoxate, octisalate, octocrylene, oxybenzone, padimate O, and sulisobenzone. For ingredients of this group to move to the GRASE category, additional safety and effectiveness data are needed.

Also non-GRASE: combinations of sunscreens with insect repellents are non-GRASE. Sunscreen should be applied liberally every 2 to 3 hours, where insect repellant is generally applied much less frequently—maybe 1 to 3 times daily, depending on the repellent’s strength the child’s age. Therefore, the sunscreen/repellent combination is not recommended.

GRASE formulations for sunscreen include oils, lotions, creams, gels, butters, pastes, ointments, and sticks are GRASE. Because of particle size and concern about unintended inhalation risk and flammability concerns, sprays and powders are GRASE subject to proposed testing. Wipes, towelettes, body washes, and shampoos are excluded from the GRASE category because there are no data to show they are safe.


The FDA has proposed that sunscreens under SPF 15 be taken off the market and that the maximum SPF be 60 to 80. The agency further recommends that all sunscreens SPF 15 and above meet broad-spectrum requirements, especially against UVA. Labels must prominently show consumers the SPF value and include an alphabetical list of ingredients. Labels for broad-spectrum SPF 30 and above sunscreens can state that if used properly and with other sun protective measures, the sunscreen reduces risks of skin cancer and early skin aging caused by the sun. Water-resistant sunscreens (there is no waterproof sunscreen available) may be labeled as offering protection for 40 or 80 minutes.

Sunscreen should be applied 15 minutes before going outdoors and reapplied every 2 hours, as well as after drying off once out of the water.

 An ounce (30 g) of sunscreen should cover exposed areas of an average adult or child. Sunscreen should not be used on damaged or broken skin or near the eyes; rinse eyes with water to remove any product. Individuals should stop using a product if a rash occurs and, if it persists, consult with a doctor.


Benzene, a known carcinogen, is not an active ingredient of sunscreens, but small quantities have been detected in them. It is more likely a contaminant or by-product of another raw material that is used in manufacturing sunscreen. In 2021, Valisure, an independent testing lab, petitioned the FDA to recall more than 50 sunscreen products that had more than 3 times the FDA-recommended level of 0.1 ppm.

A colorless chemical, benzene evaporates when exposed to air. It is found naturally in crude oil, gasoline, and cigarette smoke. After multiple exposures and high levels, it can cause cancer, according to the American Cancer Society. Benzene can damage white blood cells and nerve cells and affect the size of ovaries, causing irregular menstrual cycles. Benzene in aerosol sunscreens is most concerning because more is known about inhalation of the chemical; there is less research regarding absorption through the skin. However, because sunscreen is so commonly recommended and used, the FDA worries about chronic exposure.

In May 2018, based on information on seawater analyses in Hanauma Bay, Hawaii banned the sale and use of sunscreens with oxybenzone and octinoxate to protect the marine ecosystems. The sunscreen washes off humans, gets into the water, and affects marine life, especially the coral reef, sea turtles, and monk seals, a problem that grows with increased numbers of swimmers. In addition, in humans, oxybenzyone is easily absorbed from into the bloodstream and may affect hormone production.

UVR Rays in a Car: What Your Patients Should Know

Almost all glass blocks UVB but it does not block UVA rays. The type of glass used on the front window is more photo-protective than the side windows and sunroofs. The cumulative penetration of UVA through car windows has shown to lead to skin cancers according to studies in Australia and the United States. Tinted windows for cars offer some degree of increased protection depending on the brand.

 UVA can pass through any window, including one’s house, school, train and plane windows. There are films one can apply to windows, but you also might want to suggest to your patients' caregivers to consider, when traveling, sun protective clothing to layer and/or sunscreens that can be reapplied if necessary.

The FDA suggests throwing away sunscreens after the expiration date. One may get some benefit up to 6 months past the expiration date but not the initial effectiveness. The FDA also suggests that if there is no expiration date, you should throw it away after 3 years if kept in a cool dry place.

There are medications that make you more susceptible to burns, like tetracyclines, non-steroidal antiinflammatory medications, contraceptives, sulfonamides, hydrochlorothiazide, sulfonylureas, and psoralens. Some medical conditions can also be associated with sun sensitivity, such as lupus erythematosus, or polymorphic light eruption, and some genetic disorders.

Infants up to 6 months old should not wear sunscreen because of their thinner, more delicate skin that allows for increased absorption of active ingredients and the vehicle. Instead, advise your families to keep babies out of the sun as much as possible and wear lightweight, closely woven protective clothing including a wide brim hat. It is always a good ideal to seek shade and one should avoid overheating. Over 6 months of age, tell parents to choose a physical block sunscreen, such as titanium dioxide or zinc oxide. Consider long sleeve sun protective bathing wear which is a good idea for any age.

Many states have recognized that half of UV damage occurs before 18 to 20 years of age as children spend a lot of time outside. States laws vary regarding how and if sunscreen can be applied at school. Half of US school districts recommend allowing students to apply sunscreen. However, since it is recognized as an over the counter drug, many schools require certain authorizations, like a parent or doctor’s note. Some say it has to be applied by the parent. Pennsylvania students can carry and apply sunscreen only if they have a note attesting that they know how to self-apply and are aware of safety precautions for handling sunscreen. Another approach by states is to provide education on sun safety and skin cancer prevention. Each state is slightly different so one should become familiar with their state’s legislation.

There are multiple strategies suggested by the CDC for providing outdoor shade at our schools including solid roof structures, cloth structures and natural shade.

 Shade Planning for America’s Schools was developed for the Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health, and Division of Cancer Prevention and Control. You can also check out the American Academy of Dermatology’s 

Sun-Safety Toolkit or the Good Skin Knowledge Curriculum

Many skin cancers can be deadly or disfiguring. It is estimated that more than 9000 people are diagnosed with skin cancer in the United States every day, and the numbers are increasing. By giving patients and their families clear guidelines, this can be preventable.

Surgeon General’s call to action to prevent skin cancer: exec summary

 US Department of Health and Human Services. Accessed April 11, 2022. 

https://www.hhs.gov/surgeongeneral/reports-and-publications/skin-cancer/executive-summary/index.html

Ozone layer protection. United States Environmental Protection Agency. Accessed April 11, 2022. 

Gruijl FR. Photocarcinogenesis: UVA vs UVB. 

. 2000;319: (359-366). doi:10.1016/s0076-6879(00)19035-4

Radiation: the known health affects of ulatraviolet radiation. World Health Organization. Accessed April 11, 2022. 

https://www.who.int/news-room/questions-and-answers/item/radiation-the-known-health-effects-of-ultraviolet-radiation

Almutawa A, Buabbas H. Photoprotection: clothing and glass. 

 2014;32(3):439-448. doi:10.1016/j.det.2014.03.016

Kwok LS, Kuznetsov VA, Ho A, Coroneo MT. Prevention of the adverse photic effects of peripheral light-focusing using UV-blocking contact lenses. 

Protection from the harsh rays of the sun is crucial for everyone—including children. Now that summer has arrived, a refresher course can go a long way in preventing skin damage and disorders due to the sun.


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