COVID-19: What Community Pharmacies Are Doing in the Hardest-Hit States

March 19, 2020

Perspectives from pharmacy associations in the states hardest hit with the COVID-19 outbreak.

“Our American society is entering into a new reality when it comes to public health,” Michael Jackson, BPharm, EVP, and CEO of the Florida Pharmacy Association (FPA) told Drug Topics® in an email. As of today, Florida’s confirmed cases of COVID-19 have grown to 390, with 9 deaths from the pandemic.1

The novel coronavirus disease has now spread to every continent with the exception of Antarctica, and to each state in the United States, with global confirmed cases surpassing 227,000 to date. The United States is currently approaching 14,000 confirmed cases.

Some of the hardest-hit states, such as California, New York, New Jersey, Washington, and Florida, have a current combined confirmed case total of nearly 6000, over half of the country’s total COVID-19 count. Refer to Johns Hopkins University & Medicine’s Coronavirus Resource Center for updated counts or see our article on online coronavirus resources for more sources.1

Washington state has been hit particularly hard by the pandemic. Washington Governor Inslee announced today a statewide moratorium on evictions, suspended utility shut-offs, and waived late fees as many residents are out of work and unable to pay their rent during the outbreak.2 New York has experienced one of the most acute surges in confirmed COVID-19 cases in the country, with over 4000 cases, and 21 deaths.1 The state has added 2 drive-through testing centers in New Rochelle and Jones Beach State Park, which have helped alleviate patient capacity.3

Community pharmacies are especially vital during outbreaks such as COVID-19; this is primarily because community pharmacists remain on the frontlines of public health by serving as direct points of access for their patients.

“As patients, their families, and communities work together to “flatten the curve” amidst the COVID-19 pandemic, access medications to treat chronic diseases, behavioral health conditions, and over-the-counter symptom management is vital,” Ken Thai, PharmD, president of the California Pharmacists Association (CPhA), wrote in an email. “Pharmacists in communities across the state are upholding their oath to serve their communities to ensure that patients can live happier, healthier, and safer lives by bringing the care to the patients’ doorsteps whenever possible.”

Dr Thai added that, as grocery and convenience stores are forced to limit access, many neighborhood independent pharmacies are the last community resource for basic hygiene and health needs.

“Pharmacists can provide direct clinical consultation on managing symptoms with over-the-counter medications and be a direct line to primary care providers to authorize necessary refills for patients,” he wrote. “As the ability to test for active infections, immunizations, and treatments for COVID-19 become available, having access to a neighborhood pharmacy (usually within 5 miles or less) will increase access significantly thereby affording the state the ability to quickly and successfully beat this pandemic.”

Drug and supply shortages remain a concern. Thai explained the 3-pronged considerations in identifying drug shortages: “There are 3 areas to consider with potential drug shortages in relation to the COVID-19 outbreak: symptomatic treatment, maintenance of chronic health conditions, and disease treatment.”

Thai noted that, considering that the symptomatic presentation of COVID-19 has similar features as the common cold or flu, many OTC medications can be used.

“However, as members of the community preemptively purchase the medications to manage fever, coughs, and body aches, there is a steady demand put on the limited supplies that community pharmacies, chain drug stores, and grocery stores have in stock,” he wrote. “Anecdotally, we are starting to see the cold/flu aisles of stores being cleared out.”

Related: Study Suggests Digestive Symptoms May Be Associated with COVID-19

“As for the management of chronic health conditions, the current supply and future supplies need to be considered. Patients and prescribers are requesting early refills and extra days’ supply with local counties requesting all non-essential community members to quarantine themselves. Most pharmacies are prepped with inventory to handle their normal prescription volume for typically 1 to 2 months; however, it will be on a case-by-case basis of certain medications potentially being out of stock in the pharmacy and also from drug suppliers. Another factor to consider is the future production of these medications as most of the active pharmaceutical ingredients (API) that drug manufacturers use comes from single source suppliers that had to halt productions amidst the outbreak.”

“Finally, treatment guidelines of COVID-19 infections have not been finalized, but preliminary studies out of France, suggest that chloroquine and hydroxychloroquine could be potential medications for fighting off the infection,” Thai said.4

According to Thai, local independents have already reported that the price of these medications from secondary suppliers is already increasing, which will be an emerging concern. Moreover, as vaccinations are developed, community pharmacies will be primed and ready to administer vaccines to the community, he added.

In Florida, Jackson identified several key procedures which allow pharmacists expanded authority, and also indicated areas of improvement.

“Florida's governor has the ability to issue executive orders to provide regulatory relief on many fronts. We also have a health department lead by a state surgeon general that has additional authority to remove barriers driven by public policy,” Jackson said. “Governor DeSantis has issued both a public health emergency order as well as a state of emergency order which provides new authority for pharmacists to assist patients with their refills and removes certain prescription barriers in place by pharmacy benefit manager plan designs. There are also additional initiatives under way such as filing for and receiving a request from the Center for Medicare and Medicaid services for a waiver to allow policy changes to help expedite patient care services in the Medicare, Medicaid and CHIP program. Still there is more that needs to be done. The current structure around direct and indirect renumeration (DIR) fees is a serious barrier to pharmacies that need resources to help the public. These fees must be suspended if our providers are going to make a difference.”

Jackson also commented on Florida’s passing of a state bill that allows pharmacists to test and initiate treatment for influenza and Group A streptococcus.

“The Florida House and Senate has taken a position of unprecedented support of the services that Florida's pharmacists can provide,” he said. “The Florida House and the Governor approved sweeping changes to the way that pharmacy is practiced in this state.  It was a clear message and overwhelming strong support by our state that pharmacists can and need to do more for our citizens. We have over 21 million Floridians living in this state with over 1000 a day moving here. The demand for health care services is not going to decline. With the changes to the pharmacy practice act in House bill 389, pharmacists can make a difference.”

Thai also praised California’s state response to COVID-19, citing the importance of a coordinated response between the state and pharmacy professionals. “The California Legislature and the Governor of California worked collaboratively to pass emergency funding measures,” he wrote, “The landmark legislation enabled a coordinated response between healthcare facilities, local governments, and schools to ensure effective treatment of COVID-19 and strict preventative measures to limit its spread.” 

Related: NCPA, NACDS Underscore Role of Community Pharmacists in Fighting COVID-19

State pharmacy associations are offering plenty of resources for pharmacists to navigate these unprecedented times. The Washington State Pharmacy Association (WSPA) has provided their pharmacists and health care providers with a COVID-19 resource page with links to reputable COVID-19 sources.5 The WSPA additionally released their own set of guidelines for pharmacy practitioners in maintaining their health in order to continue to provide customers with the help they need, related to COVID-19 or otherwise.6 The Pharmacists Society of the State of New York (PSSNY) has provided Resources for Pharmacists with updated New York state news.7

The California Pharmacists Association (CPhA) has been especially proactive by offering residents social media alerts in addition to their resource page. With close to 870 confirmed cases and 16 deaths from COVID-19, the state has implemented multifaceted and innovative responses, including taking advantage of pharmacy students.

“California Pharmacists Association (CPhA) has created a valuable resources page, including a summary of actions from the Governor of California…and links to important resources for pharmacy and health care workers in particular” Thai wrote.8

“Pharmacy schools are one of the many institutions that have had to cancel classes for the  foreseeable future. Pharmacy students are highly educated and trained, and available to assist community pharmacies as they care for communities. As such, CPhA is creating a student-pharmacy connection portal to ensure that our front-line pharmacy professionals can contact students able to volunteer under their supervision, thereby increasing our support of pharmacists on the front lines of care.”

The FPA has also taken considerable steps in informing the state’s pharmacists. “On a regular basis the Florida Pharmacy Association has been sharing with our members important information to help them with their practices and also to take necessary steps to safeguard staff. We are also managing a very high volume of inquiries from stakeholders seeking current information on CDC guidelines, pharmacists authority in advance practice areas and patient care” Jackson said.9

As the virus continues to spread, independent pharmacists have prioritized the availability of COVID-19 information, as well as taking precautions to limit the spread of the virus.

Peter A. Kreckel, RPh, manager of Thompson’s Pharmacy, has instilled measures to tackle the pandemic at his independent pharmacy, which is based in Pennsylvania. “My staff, every hour on the hour, have to wash their hands. That’s when I wipe down all the counters and wipe off the door with a bleach rag” he told Drug Topics® in an interview.

“We also have a drive through – this is one case where I welcome the drive-through because it is decreasing contact. When people come into my pharmacy and get in line, I separate them. I say, ‘You 2 need to move apart 6 feet because of the social isolation we’re doing.’ I will enforce that.”

In addition to enacting mitigation efforts in his pharmacy, Kreckel has also assembled a comprehensive educational flyer that he has distributed to his customers, and has encouraged his colleagues to use as well. It is also offered as an attachment in this article. “Now is not the time to be competitive,” Kreckel said. “Now is the time to share our toys, share our information, but not our germs.”

References:

1. Coronavirus Resource Center. Johns Hopkins University & Medicine website. https://coronavirus.jhu.edu/map.html. Accessed March 19, 2020.
2. Coronavirus: Gov. Inslee places 3-day moratorium on evictions as case numbers increase. Kiro7 website. https://www.kiro7.com/news/local/coronavirus-gov-inslee-places-30-day-moratorium-evictions-case-numbers-increase/XIDPHMLVOJAAREQ5YCL75367PU/. Accessed March 19, 2020.
3. N.Y. Now Testing 7,500 Per Day for Coronavirus: Live Updates. NY Times website. https://www.nytimes.com/2020/03/19/nyregion/coronavirus-new-york-update.html. Accessed March 19, 2020.
4. Smith DK, Sullivan PS, Cadwell B, et al. Evidence of an Association of Increases in Pre-exposure Prophylaxis Coverage With Decreases in Human Immunodeficiency Virus Diagnosis Rates in the United States. Clinical Infectious Diseases. 2020, ciz1229, doi: https://doi.org/10.1093/cid/ciz1229
5. News & Press: WSPA News. Washington State Pharmacy Association website. https://www.wsparx.org/news/493599/WSPA-COVID-19-Resource-Page.htm. Accessed March 17, 2020.
6. WSPA Guidance to Pharmacy Practitioners for Safe Practice During COVID-19 Outbreak [news release]. Washington State Pharmacy Association website. https://www.wsparx.org/news/492218/WSPA-Guidance-to-Pharmacy-Practitioners-for-Safe-Practice-During-COVID-19-Outbreak.htm. Accessed March 18, 2020.
7. Coronavirus-Resources for Pharmacists. Pharmacists Society of the State of New York, Inc. website. https://pssny.site-ym.com. Accessed March 18, 2020.
8. COVID-19: Resources & Updates. California Pharmacists Association website. https://cpha.com/covid-19-resources/. Accessed March 18, 2020.
9. COVID-19 Resources. Florida Pharmacy Association website. https://www.floridapharmacy.org/page/COVID19. Accessed March 18, 2020.

download issueDownload Issue : Drug Topics April 2020