05 Nov A Review of State Emergency Prescription Refill Protocols

November 5, 2014 – The recent Ebola outbreak in West Africa and its spread to other countries serves as an urgent warning for US health care systems to be adequately prepared for any emergency. Community pharmacies and pharmacists play a distinct role in our health care system with established relationships with patients and local, state, and federal departments of health as well as accessible distribution networks that remain critical during a public health emergency (PHE)¹. Success in the disaster response after Hurricane Katrina was partly attributed to pharmacy continuity services – allowing patients to receive prescriptions from their community pharmacist who ensured safety and accuracy while avoiding crowding of emergency departments². 

For pharmacists to adequately prepare for potential disasters, it is imperative for all states (and the District of Columbia) to clearly define emergency prescription refill protocols and allow pharmacists to dispense an emergency 30-day supply of medications, specifically during times of a public health emergency, and to make this information readily available and accessible to pharmacists and the public.

An emergency prescription refill is defined as dispensing a prescribed drug without practitioner authorization, if in the pharmacist’s professional judgment, the prescription drug is essential to the maintenance of the patient’s life or to the continuation of therapy. An emergency prescription refill is necessary during normal day-to-day operations when contact with the authorizing practitioner cannot be made. 

After a national review of state laws and regulations of pharmacy practice (including the District of Columbia), board of pharmacy and state department of health websites, it is clear that emergency prescription refill protocols during a public health emergency vary widely state-by-state and are poorly organized. 

Although we see a majority of states allowing for emergency prescription refills, these emergencies are for non-specified emergencies. The intent behind the law in such situations generally applies to everyday “emergencies” wherein prescriber contact cannot be made and a 72-hour emergency supply is authorized to allow for continuity of care through a weekend or until an appointment can be made. In order to adequately prepare for a disaster response, wording in laws or regulations must be specific to a public health emergency which can last for extended periods of time beyond 72 hours.

More than half the states only allow for a 72-hour emergency supply or no emergency supply at all. A 72-hour emergency supply may not be adequate for certain public health emergencies. During Katrina, one health care team discovered that dispensing 14-day supplies of medications was not enough to provide continuity of care and 30-day supplies to displaced disaster victims was preferred³. Moreover, pharmacists may be hesitant to dispense only a 72-hour supply due to medication-packing limitations and inventory control⁴.            

As changing or adding state laws may be a cumbersome and arduous process, all state board of pharmacies without current laws regarding emergency prescription refills by pharmacists during a public health emergency are highly encouraged to initiate the process in order to be properly prepared for disasters in the future. In the meanwhile, it may be easier to leverage state boards of pharmacy to add umbrella rules as the boards have the power to regulate pharmacy practice under current legislation.

At the very least, boards of pharmacies and state departments of health must have emergency response protocols readily available and accessible for pharmacists and the public to access before as well as during an emergency to ensure adequate preparedness and minimize PHE consequences. If pharmacists are not aware of emergency protocols, it hinders disaster preparedness and makes it difficult to assist in management when a disaster hits.

Even during normal day-to-day operations, obtaining a prescription refill can be a complicated process for a patient.  By removing practitioner authorization for refills during a PHE, community pharmacists can ensure quality patient care and continuity of medical services. Pharmacists are a vital member of the health care team, and with a proper infrastructure, they can make a huge impact in during a disaster and in the recovery phase.

References

1. CDC, NACDS, APhA, ASTHO, NACCHO. Leveraging Partnerships Between Public Health and Pharmacies to Enhance Medication Dispensing Capabilities During Emergencies. April 2014. Available at: http://preparednesssummit.org/wp-content/uploads/2014/03/WEDNESDAY-Leveraging-Partnerships-Pharmacy-FINAL-SLIDES.pdf. Accessed 10/29/2014.
2. Joy TL, Kemp HN. Managing the Hurricane Katrina disaster in the Midwest. J of Trauma Nursing. 2007; 14(2): 70-72.
3. Currier M, King DS, Wofford MR, Daniel BJ, Deshazo R. A Katrina experience: lessons learned. Am J Med. 2006; 119(11):986-998.
4. Shepherd, MD. Examination of why some community pharmacists do not provide 72-hour emergency prescription drugs to Medicaid patients when prior authorization is not available. J Manag Care Pharm. 2013; 19(7): 523-533f.