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T.J. Griffin, RPh
Chief Pharmacy Officer

PharMerica

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Preserving Medication Access During Emergencies.

Steps to Preserving Medication Access

Extreme weather, man-made threats and other emergencies can cause long term care facilities to lose power, shelter in place or even evacuate, posing potentially serious health consequences for the elderly and disabled. To minimize the impact of these crises on operations, the Centers for Medicare and Medicaid Services released a final rule, Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, in 2016, with a compliance effective date of November 15, 2017. And some states impose additional requirements for facility emergency plans.

Under these directives, in order to ensure the health and safety of residents before, during and after a crisis, facilities must establish policies and procedures to address a range of issues enterprise-wide, including meeting the needs of those residents who require prescription medications. Since continuous availability of life-and-death medications starting immediately after and for days following an extended emergency is crucial to this vulnerable population, ensuring dependable prescription delivery services is critical to mitigate risk.

Pharmacy Disaster Planning

A facility’s robust emergency preparedness plan should include standard operating procedures for ensuring vital supplies of medication when a disaster strikes to mitigate risk. Central components of a center’s planning should include:

  • Stock a 5 to 14-day supply of medications for all residents
  • Secure expanded or extra emergency drug kits and maintain them in strategic points throughout the facility, ensuring security safeguards for kits with controlled substances
  • Maintain a profile of each resident that includes the names of their medication(s), dosage, and frequency
  • Develop a process to collect and transport at least a three-day supply of medications in case of evacuation, with a plan to keep medications cool, if necessary
  • Design a plan for assembling medications for inclusion in a go pack or resident survival kit
  • Ensure maintenance of residents’ regular medication schedules with medication reminders

Many of these preparatory actions can be undertaken by center staff directly. However, depending on the nature of the emergency, a facility may be impacted for an extended period of time. In those instances, a center should work closely with its long term care pharmacy partner. These pharmacies should have their own preparedness plans for maintaining access throughout a disaster that include steps such as filling prescriptions in advance, modifying delivery schedules, and developing procedures for deliveries when an area’s infrastructure has been affected.

PharMerica’s Emergency Protocols

To help facilities prepare for disasters, PharMerica has protocols that outline the company’s actions when emergencies occur at the pharmacy or the long term care facility, including:

    • Upcoming Prescription Refills: PharMerica mobilizes staff to process and deliver prescriptions in advance of impending emergency scenarios.
    • Backup Pharmacy Locations: In the event that a disaster of a large enough magnitude to render a pharmacy unable to maintain all or part of its operations, PharMerica pharmacies have reciprocal agreements with each other – as well as with external pharmacies – to provide and supply the medications needed for clients and their residents.
    • Alternate Delivery: PharMerica has arrangements with several transportation services, both on the ground and in the air, when normal delivery routes are impacted.
    • Communications: In case of communication outages, PharMerica utilizes satellite and cellular telephone and pagers. Moreover, the company has a customer service center to field local pharmacy specific calls during emergency, or clients can contact the Corporate Offices.

    In addition, PharMerica also employs event-specific procedures for foreseeable events such as snowstorms, severe flooding, and hurricanes. For example, when a potential hurricane is predicted in a service area, PharMerica will undertake several actions, including:

    • Contact clients and ask them to fax all orders needed to ensure adequate supplies to last from 5 to 14 days or, if contact is not achieved, send a blind delivery with anticipated supplies/medications
    • PharMerica’s Transportation and Logistics Team along with the Pharmacy Director/s will collaborate with PharMerica Corporate Couriers to ensure the courier’s ICs are prepared to work through the crisis. E.g. request the courier develop a letter to law enforcement for their ICs who must be allowed in restricted areas to deliver medications
    • Check availability for obtaining or borrowing aquatic vehicles or aircraft
    • Mobilize community resources to meet patient needs if delivery attempts fail
    • Send the pharmacy a transporting check list in case of an evacuation with a list of items that should be transported with resident, such as name tags, MARs, Med Carts, medications and supplies

    Preparedness Pays Off

    PharMerica clients operate facilities all over the country and experience a range of events that can drastically impact their operations. PharMerica’s disaster protocols are designed to ensure resident access to medications at all times, and are routinely tested by crises, including two recent headline-making natural disaster events.

    Hurricane Harvey: Three days before the category four hurricane swept through southeast Texas and southern Louisiana, forcing thousands of residents to be evacuated from nursing and assisted living communities in Texas, PharMerica initiated its disaster planning to ensure continuous medication availability to the 61 facilities it services in the greater Houston-Beaumont area. For the emergency, it:
    Worked with facilities and third party payers to order seven days’ worth of medications ahead of time

    • Filled prescriptions in advance
    • Ensured facilities were stocked with medications for residents and extra E-kits
    • Provided facility-specific evacuation lists to track the temporary relocation of residents

    Once the disaster struck and a state of emergency was declared, PharMerica took additional steps to ensure resident access to medications. Specifically:

    • PharMerica’s San Antonio center and other pharmacies filled prescription’s on behalf of the company’s Houston center
    • When its partner logistics company and courier’s ICs sustained losses, PharMerica reached out to the National Guard for air support to deliver IV medication to a critical patients, as well as make other emergency deliveries

    California Mudslides: During the deadly mudslides impacting parts of California in early 2018, roads were blocked and impassable, and power lines were down. But to keep life-and-death medicines in the hands of residents who were cut off from PharMerica’s normal supply route, the company moved from highways to the water.

    While the Pacific Coast Highway was closed, PharMerica utilized a daily ferry boat service to make its deliveries. One of the company’s technicians met the boat each day, then delivered the medications and supplies to nursing facilities in the area. On the weekends, PharMerica serviced its centers by Amtrak train.

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