Antiviral Medication Distribution

Texas Pandemic Influenza Regional Conference

Antiviral Medication Distribution

Texas Department of State Health Services (DSHS)And

Texas Division of Emergency Management (DEM)

August and September, 2009

Texas Pandemic Influenza Regional Conferences

Antiviral Medication Distribution www.texasflu.org

Presentation Outline

• What is an antiviral medication?• Brief Overview of Clinical Guidelines• Differences between Antiviral Medication & Vaccine• Strategic National Stockpile Overview• State Stockpile

• Overview

• Access

• Distribution

• Reporting

• Supply Chain Disruption• Key Points• Considerations

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• A medication that has activity against influenza viruses, including the novel H1N1 influenza virus

• Can be used to treat or help prevent novel H1N1 influenza

• Is only appropriate in specific circumstances

• Requires a prescription from a healthcare provider

• Is just one component of a comprehensive containment and treatment plan to help control novel H1N1 influenza

Antiviral MedicationWhat Is An Antiviral Medication?

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Treatment

1. Must be used within 48 hours of onset of symptoms for maximum effectiveness

2. Should be targeted to high risk populations• Pregnant women, children, adults with chronic diseases

(such as asthma, COPD, and diabetes)• Patients hospitalized due to novel H1N1 influenza

3. Healthcare providers should follow guidance from DSHS found at www.texasflu.org

4. Antiviral medications can sometimes be used for preventive treatment in limited situations

Antiviral MedicationBrief Overview of Clinical Guidelines

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Antiviral Medication VaccinePrimarily used to treat influenza, specialized use for preventing influenza

Used to prevent influenza

Does not build immunity in your body Helps your body build its own immunity

You are only protected from influenza while you are taking the medication if used for prevention

Once your body develops immunity, you have lasting protection

Finite amount of medication, not enough to serve everyone

CDC plans to have enough for anyone who wants it

Antiviral MedicationDifferences between Antiviral

Medication and Vaccine

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Q What is the Strategic National Stockpile?

AThe Strategic National Stockpile (SNS) is a federal government stockpile of medicine and medical supplies available to states for public health emergencies upon request by state officials

• For pandemic influenza response, Texas receives a finite amount of antiviral medications from the SNS.

• The SNS includes two types of antiviral medications – Tamiflu and Relenza.

Antiviral MedicationStrategic National Stockpile Overview

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QWhat is the State Stockpile?

AA stockpile of antiviral medication DSHS purchased from federal preparedness funds and state legislature funds & antiviral medication received as the Texas portion of the federal Strategic National Stockpile

• The state stockpile includes materials received from the SNS

• The state stockpile has a finite amount of antiviral medications that need to be used strategically

• The state stockpile includes two types of antiviral medications - Tamiflu and Relenza

Antiviral MedicationState Stockpile Overview

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Q When will the State Stockpile Be Used?

AThere are three primary purposes for the state stockpile:

• Individuals who cannot access medication through routine channels

• Public health measure needed for outbreak control

• Routine supply channels breakdown

Antiviral MedicationState Stockpile Overview

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Healthcare provider

determines if an antiviral is

appropriate

Healthcare provider

determines if an antiviral is

appropriate

Healthcare provider writes

prescription

Healthcare provider writes

prescription

Pharmacist fills prescription

Pharmacist fills prescription

Access to Antiviral Medications for Patients

Ro

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Antiviral Allocation and Distribution

Routine Channels for Access to Medication for Patients

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• Uninsured and underinsured may not utilize routine channels due to cost

• DSHS created a mechanism to serve these patients through the state stockpile where patients can access medication at low or no cost based on the patient’s need

• This mechanism uses a pharmacy distribution network that includes:

• Retail chain and independent pharmacies

• Community Health Center (CHC) / Federally Qualified Health Center (FQHC) pharmacies


Access to State Stock Medication for Patients

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Healthcare provider determines antiviral

is appropriate

Healthcare provider determines antiviral

is appropriate

Healthcare provider writes prescription

Healthcare provider writes prescription

Health Care Provider refers

patient to a pharmacy that has

state stock

Health Care Provider refers

patient to a pharmacy that has

state stock

Access to State Stock Antiviral Medications for Specific Patients

Healthcare provider identifies state stock

is needed

Healthcare provider identifies state stock

is needed

Pharmacist fills prescription from

state stock

Pharmacist fills prescription from

state stock


Access to State Stock Medication for Patients

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Local Health Departments

1. Local health departments addressing public health outbreak control can access the state stockpile if local supplies are nearing or at depletion.

2. The local health department should contact the health service region to make this request.

Antiviral MedicationPublic Health Measures to Address

Outbreak Control

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Routine Supply Channel for Health Care Entities

Access to Antiviral Medications for Health Care Entities

Medication supply runs

low


low

Order from supplier

Order from supplier Treat patientsTreat patients

Ro

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Ent

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If routine supply channels break down, the Health Service Region has a mechanism to provide supplies to health care entities.

Access to Antiviral Medications for Health Care Entities


low


low

Order from supplier

Order from supplier Treat patientsTreat patients

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Ent

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Routine Supply Channel for Health Care Entities

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Chain Pharmacies

Independent Pharmacies

FQHCs / CHCs

DSHS

Local Health Departments

Uninsured/ Underinsured Populations

Healthcare Systems

DSHS Health Service Region


Distribution System for State Stock Antiviral Medication

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• DSHS will track state stock antiviral medication usage and inventory levels.

• Entities receiving state stock of antiviral medications will be required to report individual usage data and inventory levels to DSHS on a regular basis through an electronic system.

Antiviral MedicationReporting

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Uninsured and UnderinsuredUninsured and Underinsured

Outbreak Control

Outbreak Control

Supply Disruption

Supply Disruption

• For individuals who are uninsured or underinsured, antiviral medications can be distributed from the state stockpile

• Healthcare providers will have information about how to access the state stockpile for patients in need

• When required, the state stockpile can be used for outbreak control when deemed a necessary public health measure by either the DSHS Health Service Region or local health department

• Used to meet immediate health care entity needs to due to supplier disruption or unavailability

Antiviral MedicationState Stockpile Utilization Summary

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Q

A• DSHS will review epidemiological information at that time

• DSHS will revise treatment guidance if necessary to determine appropriate allocation of the remaining stockpile

What happens if the supply chain is completely unavailable ?

Antiviral MedicationComplete Supply Chain Disruption

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• Antiviral medications are appropriate only in specific circumstances

• There are a finite number of antiviral medications available

• Healthcare providers determine appropriateness of antiviral medication for patients

• Healthcare providers should make their decisions based on the guidance found at www.texasflu.org

• Antiviral medications are not a substitute for vaccine

• Seek seasonal influenza vaccine as soon as that vaccine is available

• Antiviral medications are just one component for controlling a novel H1N1 influenza virus outbreak

• Non-pharmaceutical interventions (hand washing, social distancing, staying home from work/school when ill) are key elements to reduce transmission

Antiviral MedicationKey Points

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Antiviral Medication Distribution www.texasflu.org Page 20

Antiviral MedicationConsiderations

Department of State Health Services

Department of State Health Services

• Manage state stock antiviral medication distribution (allocate, process orders, ship)

• Coordinate with stakeholders (health care providers, pharmacy partners, etc.) regarding state stock antiviral medication distribution

• Provide clinical treatment guidance at www.texasflu.org

• Track and report state stock antiviral medication usage

Local CommunitiesLocal Communities

• Guidance is available at www.texasflu.org

• Use non-pharmaceutical interventions (hand washing, staying home when sick, etc.) to reduce transmission

• Ensure continuity of operations plans do not rely on long-term antiviral medication for healthcare workers and first responders

• Entities who receive state stock antiviral medications report on usage of this medication

Antiviral Medication Distribution

Documents

state stock medication

patients antiviral allocation

medication forpatients

state stock access

state officials

distribution access

health care entities

public health emergencies