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COVID-19 Compiled Resources for Pharmacy Practice

The following information and resources have been compiled to help you in your practice during the COVID-19 outbreak. Please contact PSW if you have any additional information or questions. We will do our best to keep information up-to-date. 

Updated 3/26/20

Important to Share with Patients and Communities
Stay home as much as possible!

Talking points for your patients and for pharmacists

 

Personal Protective Equipment (PPE)

At this time, with PPE in VERY short supply, PSW recommends all pharmacy personnel (regardless of practice setting) follow CDC and FDA recommendations for the conservation of PPE. In general, there are a number of strategies pharmacy practice teams can use to minimize or eliminate the need for PPE use through alternative methods of patient interaction. Individual practice setting needs should be considered, but PPE should be conserved for frontline clinicians treating, testing, or ruling out patients with or with suspected COVID-19.

Information is also available from CPESN USA on strategies for keeping your community pharmacy practice staff and patients safe. Click here to access.

 

Compounding Hand Sanitizer

FDA announced that they will take no enforcement action against licensed professionals, like pharmacists, who make and sell hand sanitizer as long as they use high-quality ingredients and follow the FDA rules. National organizations are seeking further clarification from FDA. In the meantime, FDA has offered the following email address to pose specific questions: compoundingpolicy@fda.hhs.gov.

The FDA’s guidance for the temporary compounding of hand sanitizer can be found here.

During this pandemic, USP supports State Board and other regulators using risk-based enforcement discretion related to the implementation of USP compounding standards and the compounding of alcohol-based hand sanitizers for consumer use. (questions for USP should be directed to CompoundingSL@usp.org)

 

Emergency Regulatory/Statutory Relief

The following is a growing list of waivers from Pharmacy Examining Board and Executive Orders providing regulatory or statutory relief in the public health emergency.

Rule being waived: When compounding personnel exit the buffer or segregated compounding area, a gown may be removed and retained in the ante area or segregated compounding area if not visibly soiled, to be worn again during the same work shift. Coveralls, shoe covers, hair and facial hair covers, face masks, eye shields, and gloves shall be replaced with new ones before re−entering the compounding area.

Because this rule has been waived, coveralls, shoe covers, hair and facial covers, face masks, eye shields, and gloves may be reused.

  • Additionally, PSW has made formal requests for waivers to laws relating to out-of-state licensed pharmacists practicing in Wisconsin temporarily and the ability of pharmacists to dispense in locations other than licensed pharmacies. We will keep members posted as these waivers are approved.

 

Emergency Fills

Wisconsin law allows pharmacists to dispense a 7-day supply of a prescription without refill authorization if the following conditions are met:

  • The pharmacist attempts to get authorization for a refill, but cannot reach the prescriber.
  • The patient is on a consistent drug therapy.
  • The patient has previously filled the prescription at the same pharmacy or within the same chain.
  • The drug is not a controlled substance.
  • The patient may receive one emergency supply per drug per year.
  • If the prescriber has indicated “no extensions” on the prescription order or has told the pharmacy it cannot extend the prescription, the pharmacy may not dispense an emergency supply
  • The emergency supply is for a maximum 7-day supply (exception: insulin/other drugs not packaged for 7-day supply).

 

Medicaid Policy Changes

As of March 20, 2020, providers will be allowed to override the overuse precaution (early refill or ER) prospective drug utilization review (DUR) alert for all drugs, except for controlled substances that are currently listed on the Drug Authorization and Policy Override Center Early Refill Drugs list.

Additionally, providers are encouraged to review the Three-Month Supply Drugs table, which is a list of drugs that are either allowed or required to be dispensed in a three- month supply. Providers are encouraged to dispense drugs in a three-month supply when possible.

In emergency situations, pharmacy providers are able to dispense a 14-day emergency supply of a drug when a member receives a prescription for a covered drug with prior authorization restrictions. Drugs dispensed in emergency situations do not require prior authorization. Providers should review the Expedited Emergency Supply Request Drugs table for additional information.

Providers and members are also encouraged to consider mail delivery services for prescription drugs. Wisconsin Medicaid-enrolled pharmacies are permitted to dispense and deliver prescription or over-the-counter medication to members via the mail when program requirements for coverage are met.

ForwardHealth Update here.

 

Signature Requirements

PSW is aware that many health plans require signature upon pick up or delivery of medications. PSW is pursuing regulatory/contractual relief of signature requirements. In the interim, please consider how proper hand hygiene can be practiced and infection control can take place at point of signature to protect pharmacy staff and patients.

CMS has issued guidance stating, "We are making clear that HHS does not require and will not audit for patient signatures as proof of delivery for any medications, including for controlled substances." Though CMS does leave it up to plan sponsors (health plans/PBMs) on how they proceed.

Current policy requirement from Navitus: (incorrectly relayed on 3/18 PSW webinar)

“At this time, we are still expecting that if members are picking up their medications in person the standard practice of obtaining signatures will remain in place. If medications are being delivered locally, that may be noted with the date and time delivery was made. If the deliveries are via a currier or sent Fed-ex, UPS or USPS, the electronic tracking and delivery timestamp will suffice.”

 

Will pharmacies need to close?

Healthcare facilities, including pharmacies, are exempt from the current Wisconsin prohibition on gatherings of more than 10 people. In other states and municipalities where shelter-in-place or broader restrictions on individuals leaving their homes have been enacted, pharmacies have consistently been considered an “essential service” that is not subject to these closure requirements.

 

Returning to Work

The CDC has released interim guidance “Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19”

From Wisconsin Department of Health Services Bureau of Communicable Diseases on 3/20/20...

Recommendations for Active Symptom Monitoring for Employees in Health Care Settings where Community Transmission of COVID-19 is Occurring

  • DHS recommends that all health care providers, including inpatient, outpatient, and residential care facilities, actively monitor staff for symptoms consistent with COVID-19.
  • Employers should ensure that staff involved in patient care are systematically evaluated for symptoms of respiratory infection, including temperature monitoring and query for specific symptoms before every shift.
  • Providers who develop fever or respiratory symptom MUST be excluded from work for at least 7 days. If testing for COVID-19 is performed and is negative, staff may return to work after they have been afebrile for 72 hours.
  • Health care providers who have been exposed to COVID-19 but are asymptomatic do not need to be excluded from work, but should self-monitor symptoms.

Health care workers must stay home when they are sick.

It is critically important at this time that all providers assume personal responsibility for reducing the spread of respiratory viruses by not reporting to work when ill, including if they only have mild symptoms that would not normally cause them to miss work. Employers should reinforce the message that during the current pandemic, the usual tendency for staff to “push-through” and come to work when mildly ill is not acceptable. To support staffing needs, employers should explore available resources for back-up coverage and discourage vacations during the next 60 days. When possible, employers should re-evaluate existing sick leave policies to ensure they do not pose unnecessary burdens on essential staff who must miss work due to illness.


Working Remote

There is nothing in Wisconsin state law that prohibits a pharmacist from remotely completing DURs or prescription verification. Pharmacy technicians may complete tasks under the general supervision of a pharmacist. General supervision does not require on-site supervision; therefore, technicians are able to complete order entry and other tasks remotely if the supervising pharmacist is regularly available to coordinate, direct, and inspect the work of the technician.

 

Student Experiential Rotation Contacts

The COVID-19 public health emergency has raised a great deal of questions related to experiential rotations, student roles, and graduation requirements. PSW is in close communication with Wisconsin’s schools of pharmacy and facilitating dialogue between the schools and the Wisconsin Pharmacy Examining Board. Site specific experiential education questions related to the COVID-19 pandemic should be directed to the following individuals.

 

Treatment of Symptoms – No Ibuprofen

On March 17, the World Health Organization (WHO) recommended that people suffering from COVID-19 symptoms avoid taking ibuprofen. While the evidence is being reviewed, WHO recommends the use of acetaminophen for self-medication. Also news from BMJ.

On March 19, this recommendation is being further reviewed and reconsidered by experts. Pharmacists should stay tuned into rapidly changing recommendations.

 

Disinfectants/Cleaning


Tips for Community Pharmacies

  • Ask patients to use the drive thru window only (if one is available). Limit traffic in the pharmacy. Share with patients they can purchase over the counter or gift items through the drive thru.
  • Have patients not already on a sync program call ahead for refills; maximize your sync program to cut down on pharmacy trips
  • Encourage delivery to curbside/home/work place
  • Share that wait times may be longer than normal
  • Encourage patients to ask their questions over the phone, sharing that the pharmacist may need to call them back
  • Shift staff that are able to work remotely to remote work or consider how to minimize exposure of various staff roles/teams

Information is also available from CPESN USA on strategies for keeping your community pharmacy practice staff and patients safe. Click here to access.


Drug Shortages

 

Considerations in Long Term Care

CMS has issued guidance directing nursing home operators to prohibit visitors and all non-essential personnel from entering facilities.

Pharmacists that serve the high-risk populations in nursing homes and other long term care facilities should develop plans for delivery of medications that limit the contact of delivery personnel with facility staff and patients. Strategies that may provide for delivery of medications without delivery personnel entrance into a facility should be explored.

The Wisconsin Department of Health Services (DHS) has issued further recommendations for the prevention of COVID-19 in long term care facilities and assisted living facilities.

 

Well-being

To bring attention to the well-being of pharmacists, student pharmacists, and pharmacy technicians during the COVID-19 response, PSW encourages members to refer to WHO guidance and CDC information on mental health and coping in the context of COVID-19.

 

For Kiddos

This call was for PSW members to share their concerns with PSW staff and with one another and to make suggestions on how our pharmacy community can support one another. The call was advertised in a PSW member communication and was held on March 18, 2020. Questions or recommendations can be sent to info@pswi.org.

Copyright © 2020 Pharmacy Society of Wisconsin. All rights reserved.
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