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In the midst of unprecedented disaster, pharmacists and pharmacies were prepared.
Hurricane Harvey hit the Texas Gulf Coast last Friday and then stalled there as a tropical storm, leading to massive flooding that forced thousands of evacuations. Huge areas have been left without power or road access, creating a nightmare for those still caught in the storm. Experts are calling the amount of rainfall “unprecedented;” the National Weather Service even had to update their rainfall scales with more colors to accurately map the disaster. The storm hit Louisiana today and is expected to work its way further up, reaching as far north as Kentucky on Saturday.
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But even in the middle of this nightmare, health-care providers still continue to operate. Several hospitals, especially in Houston and its surrounding areas, have been forced to evacuate-in one case, rising flood waters made an evacuation impossible just hours after the order had been given. But many more continue to operate, in spite of difficulty transporting patients and for health-care workers to get to work.
Fig. 1Pharmacists are also there in the thick of it. The latest data from HealthcareReady, an organization that tracks health-care site availability in emergency areas, shows that 18 counties are currently operating with less than 75% of pharmacies open. See Fig. 1 for more data; counties in green are operating with at least 90% of pharmacies open, counties in yellow have between 75% and 90% of pharmacies open, and red are counties operating with less than 75% of pharmacies in operation.
Even when stores are closed, pharmacists are on the move. HEB and Walmart both sent mobile pharmacies to affected areas, allowing pharmacists from other areas to help out. CVS will be also be sending out mobile pharmacies, and the chain has also committed to donate $200,000 in cash and supplies.
HHS tweeted out a video of pharmacists preparing antibiotics and other treatments. Pharmacy organizations are helping out too: NCPA, APhA, and ASHP have all said that they are reaching out to members in affected areas and are trying to help wherever they can and where they are needed.
But in spite of the terrible storms, many say that the problems are not as bad as they could have been for pharmacies. Audra L. Conwell, CAE, Executive Director and CEO of the Alliance of Independent Pharmacists of Texas, told Drug Topics that because the governor was so quick to declare a state of emergency, it allowed state boards to prepare for the onslaught.
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Under the state of emergency, all pharmacists in Texas have been granted temporary dispensing powers. Pharmacists can refill a prescription (up to a 30-day prescription) even if the prescriber cannot be reached, based on their discretion. This does not apply to Schedule II control substances, potentially negatively affecting pain patients. Under the CMS 1135 waiver program instituted in states of emergency, certain Medicare, Medicaid, and CHIP requirements have been waived. Insurance providers are responding to the emergency to make it easier for patients; many, such as UnitedHealthcare and Aetna, are making it possible for patients to refill their medications early. CVS Caremark, CVS’s PBM, will provide one-time emergency refills of a 10-day supply of medication for plan members at local pharmacies in affected areas.
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Conwell said that because “everybody acted so quickly and procedures were in place,” she has heard of very few problems with pharmacists in the Alliance network. The process worked, she said, and patients are getting their prescriptions in a timely manner.
Walgreens reported that around 160 of its 500 stores in southeast Texas and Louisiana are closed, but that local Walgreens field leaders are attempting to reopen as many stores as possible. To prepare for the hurricane, Walgreens staged several generators throughout southeast Texas and then sent them out to a number of stores. Phil Caruso, a spokesperson for Walgreens, said that only a “handful” of stores are still operating on emergency generator power, and they would be opening stores as soon as it was safe for employees and customers. He said that Walgreens has faced similar disasters, and so they made preparations to reopen stores as quickly and safely as possible. Caruso added that there have been reports of Walgreens employees with damage to their homes, but so far, no news of anyone injured.
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Walgreens has also pledged help to the Red Cross, promising $200,000 and food and medical supplies. In particular, Walgreens was asked for items like blood pressure cuffs, glucometer strips, catheters, and wheelchairs to help meet needs.
Christopher Smith, SVP of Distribution for US Pharma at McKesson, also said that quick response has helped ease the problem. He spoke to Drug Topics from Conroe, TX, a city just outside of Houston, where the main McKesson distribution center serving customers in the Gulf Coast area is located. He said that two other Southern distribution centers are helping to keep up with demand, and there has so far been little disruption to supply lines.
Smith said that McKesson was able to make preparation for the storm, and except for pockets in Houston that were physically unreachable, there have few inventory issues, and that they are “providing next day service like always.” For harder-to-access areas, he mentioned that they are “trying to get creative,” such as by using helicopters where needed. He added that supplies like insulin are in demand, and that they are also stockpiling inventory to deal with snake bites as waters recede.
In addition to snake bites, health officials are also concerned with bacterial and viral infections from contaminated water in the weeks and months following a major flood.