AV Dist Methods

8/20/2019 AV Dist Methods

1/27

New Approaches for Antiviral Medication

Dispensing During a Pandemic:

Collaborations that

utilizes

the

community

pharmacist

Lisa Koonin MN, MPH

Centers for Disease Control and Prevention

Anita Patel, PharmD, MS


Mitchel Rothholz, RPh, MBA

American Pharmacists Association

Gillian SteelFisher, PhD, MSc

Harvard School of Public Health

Development and Support

This webinar was developed by the American

Pharmacists Association and supported by a

Cooperative Agreement provided by the Centers for

Disease Control and Prevention (CDC). The opinions

expressed in this program do not represent the

viewpoints of the CDC.

Disclosures• Mitch Rothholz, declares that his wife is an employee of

Merck and he serves on the advisory committee for

Merck and Pfizer.

• Gillian SteelFisher, PhD, MSc, declares her husband is a

consultant for

Eli

Lilly.

• Lisa Koonin, MN, MPH, Anita Patel, PhamD, MS, and

APhA’s editorial staff declares no conflicts of interest or

financial interests in any product or service mentioned in

this activity, including grants, employment, gifts, stock

holdings, and honoraria. For complete staff disclosures,

please see the Education and Accreditation Information

section at www.pharmacist.com/education .


2/27

Accreditation Information

The American Pharmacists Association is accredited by the

Accreditation Council

for

Pharmacy

Education

as

a provider

of

continuing

pharmacy

education (CPE). This activity, New Approaches During a Pandemic for Antiviral

Medication Dispensing‐ Collaboration that utilizes the community pharmacist , is

approved for 1.5 hours of CPE credit (0.15 CEUs). The ACPE Universal Activity Number

assigned by the accredited provider is: 202‐000‐12‐248‐L04‐P.

To obtain CPE credit for this activity, participants will be required to actively

participate in the entire webinar and complete an online evaluation and CPE recording

form located at www.pharmacist.com/education by September 28, 2012.

Target Audience: Pharmacists

ACPE Activity Type: Knowledge‐Based

Learning Level: 2

Initial Release Date: September 19, 2012

Learning Objectives

• Discuss the goals for an antiviral medication

distribution program during a pandemic

• Describe the current model and proposed model for

distribution of antiviral medications and the various

providers within the system

• Articulate the value of incorporating community

pharmacists within a new model of antiviral

medication distribution/dispensing during a

pandemic event.

Learning Objectives• Discuss the learnings from pharmacy simulations

conducted by CDC that identified success factors for

the new model of antiviral medication dispensing

• Identify strategies for overcoming barriers to the

implementation of

a collaborative

practice

agreement and discuss components of a

collaborative practice agreement needed to

successfully implement the new model for patient

evaluation and antiviral medication dispensing

• Describe the learnings from a Harvard University

survey of pharmacists and how the results informed

the proposed model of care delivery.


3/27

Self ‐Assessment Question #11. The purpose of exploring a new method of

pandemic antiviral distribution and dispensing is

to:A. Improve access to antivirals during an influenza

pandemic

B. Increase the burden on public health during a

public health emergency

C. Provide antivirals for free to the public

D. Ensure every American has a dose of antivirals

Self ‐Assessment Question #2

2. CDC’s pharmacy simulation exercises provided

information that:

A. Pharmacies can provide medicines during an

emergency

B. Pharmacies can increase the number of patients

served during a future pandemic

C. Usual standards of accuracy and quality control

can be maintained when dispensing antivirals

during a pandemic

D. All of

the

above


3. Collaborative Drug Therapy Management

(CDTM) encompasses the following:

A. It is a team approach

B. May include,

but

is

not

limited

to

initiating,

modifying, and monitoring a patient’s drug

therapy

C. Can be utilized in non‐emergency and declared

influenza situations

D. All of the above


4/27

CDC’s Alternative Antiviral Drug

Distribution and Dispensing Exploratory Project

Lisa M. Koonin MN MPH

Lead, Pandemic Medical Care and

Countermeasures Task Force

Influenza Coordination Unit

Centers for Disease Control and

Prevention

Timely Antiviral Treatment During an Influenza Pandemic Depends Upon Success At Every Step

Antiv iral s uscep tibi lity and

effectivenessSupply Available EUA/Regulatory issues

Public acceptance

Pharmacists acceptability

Distribution from

SNS/Commercial suppl y

chain

Provider Acceptability

Patient access to Rx

Access to med icatio n

Timely administration

CDC Antiviral Distribution and Dispensing Project

• AV Project Dates: May 2011 – May 2013

• AV Project Key Partners: ASTHO, NACCHO, American Pharmacists

Association, National Association of Chain Drug Stores, National

Community Pharmacists Association, Rx Response

• AV Project Goal: To improve the availability and access to antivirals

during an influenza pandemic

• AV

Project

Key

Activities:

• Explore the feasibility, acceptability, cost, and impact of leveraging

existing systems by sending SNS antivirals to pharmaceutical

distributors and pharmacies to distribute and dispense

• Develop processes to align with usual commercial system

practices (inventory control, pharmacy ordering, tracking, billing)

• Explore innovative financing mechanisms:

– Explore how dispensing fees could be covered for

uninsured/underinsured


5/27

Antiv iralManufacturers

SNS

LHD

SHD

NursingHomes

Various

methods

PharmaceuticalDistributors

Med Offices /Clinics

Pharmacies

Hospitals

PH Clinics

CURRENT METHOD: Antiviral Distribution and Dispensing During 2009 H1N1 Pandemic

Dispensing Locations

Various

methods

SNS

LHDSHD

Large Pharmacy

Chains

Hospitals

Med Offices/Clinics

Nursing Homes

PH Clinics

Targetingunderserved

populationsX %

Z %Distributor(s)

Independent

Pharmacies

Dispensing Locations

Chain, Big-Box,

Grocery Pharmacies

Timely Dispensing

Tribal nations?Prisons?Other?

PROPOSED METHOD FOR TESTING:Future Pandemic Antiviral Distribution and Dispensing

Triggers for Release

Amount of Release

Y %

Key Areas of Exploration

• What proportion of SNS AVDs should be sent to SHDs and what proportion to distributors?

• Leveraging inherent strengths of key participants: – Public health’s unique reach to underserved and

other populations

– Distributor and pharmacies reach

– Specific uses for state/local stockpiled antivirals?

– Distribution strategies: “prime the pump”, per‐capita, demand‐based, mixed model?

• Financing: – How to assure that cost/payment is not a barrier?

• Acceptability, feasibility, cost, reliability?


6/27

Alternative AVD Distribution and Dispensing

Plan Must be Feasible and Acceptable

New

Approach drafted

Fea si bl e? A cc ep ta bl e? YES

Possible New

Policy

NO

Back to the

drawing

board!

• Learn from H1N1

• Explore possible solutions

• Feedback from PH and other partners

• Legal barriers

• Mathematical modeling > supply/demand

• Commercial partner interest (RFI/RFP)

• Retail pharmacy throughput/simulations

• Reach to non‐pharmacy locations

• Access for uninsured

• Ability to track assets/information flow

• Cost analysis

• Public Health

• Distributors

• Pharmacy execs

• Pharmacists

• Providers

• Public

Assumptions

• Rapid access to antiviral drugs is critical

• Stockpiled assets will be the primary resource for AVDs in the US

• Public health continues to have a key role in AVD distribution and dispensing

• This system will be scalable

• System rules will be transparent and adapt as needed

• Information exchange is critical for all partners

“Scripted Surge”: Preliminary Findings from

CDC’s Pharmacy Throughput Simulations

American Pharmacists Association Webinar

September 19, 2012

Anita Patel, PharmD, MS

Health Scientist

Division of Strategic National Stockpile

Office of Public Health Preparedness and Response



7/27

Exercise Purpose

• Simulate a pandemic scenario at a pharmacy

to

assess

the

impact

of

dispensing

government provided antiviral medications in addition to normal pharmacy prescriptions during an emergency

– These drills will help to assess throughput in pharmacy surge situations and identify bottlenecks in the prescription drug dispensing process

1

Matt’s Medicine Store,

Independence MOPharmacy Simulation 1:

Independent pharmacy

March 11, 2012

2

Walgreens, Chicago, IL

Pharmacy Simulation 2:

Traditional chain pharmacy

June 24, 2012

Scripted Surge: When and

Where?

1. Determine the average time required for a community

pharmacy to dispense prescription drugs in a pandemic surge

situation

2. Determine number of patients served and scripts filled/hour

and

assess

accuracy

of

prescriptions

filled3. Identify specific “bottlenecks” in the dispensing process

4. Examine the quality of the dispensing experience for:

– Each pharmacy “patient” during the exercise

– Pharmacy staff during the exercise

2

Exercise Objectives


8/27

• Use of normal pharmacy processes, systems and materials

• Dispensing under

traditional

pharmacy

practice

principles

• Pharmacy operating at anticipated surge levels

• Mirror normal prescription environment – How prescriptions enter pharmacy

» Hardcopy, called, faxed, electronic

– Antiviral Rx plus regular Rx

– Ratio of insurance related problems

– Estimates of patient related problems

• 2 run‐throughs – Approximately 90 minutes in length each

Exercise Design

• The US is at the peak of the worst influenza pandemic in decades

• A new pandemic vaccine is still being made and is not yet available

• Antiviral drugs are the only treatment for the infection – There are two antiviral drugs Tamiflu® and Relenza®

• Commercial supplies of antiviral medications have been depleted

• A proportion of the federal stockpile of influenza antiviral medications has been distributed to local pharmacies to dispense to patients with a prescription

Setting the Stage

The Scenario

What Happened?• 27 actors for each drill

2

• Each was given patient

profile cards

• “Personal”information

• Information about

their insurance, name

of their doctor, and

the medications they

have been

“prescribed”


9/27

2

Patient Profile Card

Back of Card

• Along with ‘prescriptions', ‘patients’ handed one or more of the following cards to pharmacy staff to help present a more realistic scenario

– Green cards = Used for payment

– Blue cards = Insurance coverage

– Orange card = Problem (affixed to green or blue cards)

– Red card = Timed actor

• Normal pharmacy prescription errors were also included for pharmacy staff to catch as part of normal dispensing processes – Dosing errors, patient allergies, drug interactions

2

Volunteers

Patient Cards

What Happened? (cont.)• Pharmacists filled “prescriptions” as on a normal, but busy day at peak

of an influenza pandemic

• “Patients” presented with prescriptions and scenarios

• Pharmacists filled all “prescriptions” and provided services as they

normally would

– Except NO REAL MEDICATIONS WERE HANDLED OR USED


10/27

The Simulation Cell (SimCell)• Problems requiring a 3rd party to resolve were simulated

by Controllers staffing phones at the SimCell

2

• Problems with the patient insurance

• Problems associated with the

method of payment

• Missing/incorrect

information on prescription

• Interactions with physicians

to verify prescriptions as

needed

Timed randomly selected actors

at four different points in the

pharmacy

1. entry to the pharmacy

2. drop‐off of the prescription

3. prescription pick‐up

4. exiting the pharmacy

Objective 1 ‐ Determine the average time required for a for community pharmacy to dispense

antiviral drugs during surge scenario

Objective 1: Time Results Drop off to pick up of

prescriptions

(Mean = 23.8 minutes)Time (minutes)

25.4

Independence, MO


11/27

Summary of people served and prescriptions filled in both drills

(Run 1 and Run 2)

Objective 2aDetermine number of patients served and

scripts filled/hour

MO Run 1 MO Run 2 CHI Run 1 CHI Run 2

Duration of run (minutes) 84 90 90 90

Number people served 29 41 35 35

Number people picked up multiple scripts 4 11 7 9

Throughput (number people serviced per hour) 20.7 27.3 23.3 23.3

Number scripts filled 34 55 44 45

Throughput (number scripts filled per hour) 24.3 36.7 29.3 30.0

• Assessing accuracy

– Volunteers turned in prescriptions to QA

evaluators after leaving the pharmacy

– Criteria examined

• Patient Name

• Medication

• Dose/Strength

• Quantity

• Instructions for drug use

Objective 2b. Accuracy

• Overall high level accuracy observed

Objective 2b.

Assessing Accuracy: Independence, MO

Patient

N am e M edicat ion

Dose/

Strengt h Q ua nt it y I ns truct ions

Overall

Correct

Prescriptions 99% 98% 100% 99% 98%

Run 1 (n=34)

Correct

Prescriptions 100% 100% 100% 100% 97%

Run 2 (n=55)

Correct

Prescriptions 98% 96% 100% 98% 98%


12/27

• Overall high level accuracy observed

Objective 2b.

Assessing Accuracy: Chicago, IL

Patient

Name MedicationDose/

Strength Quantity Instructions

Overall

Correct

Prescriptions 99% 98% 99% 99% 96%

Run 1 (n=34)

Correct

Prescriptions 98% 98% 100% 98% 95%

Run 2 (n=55)

Correct

Prescriptions 100% 98% 98% 100% 96%

Top bottlenecks perceived by pharmacy staff

1. Counseling

2. Inputting prescription information into the

computer

3. Taking doctor calls

4. Taking in prescriptions from patients

5. Other

• Technology – Printers, computers, register issues

• Attaining accurate prescriptions from prescribers

Objective 3. Bottlenecks

Both drills

Objective 4. Quality of the dispensing experience for each pharmacy “patient” during

the exercise

Independence,

MO

Chicago, IL


13/27

• Pharmacies were able to dispense 1.5‐2.5x more scripts than normal script peak rate – Using normal surge staff

• Solutions to bottlenecks may need to be implemented

– Adjust normal

practice

• Increase staff

• Clarity on each staff role

• Adjust flow of patients or script dispensing process

• Use of advanced technology (eScripts, novel ways of processing Rx {tablets), video counseling)

• Key artificialities/limitations of the exercise: – Learning curve on disease and drugs could not be accounted for in a one day

drill• Ability to cope with surge may improve over time from start of pandemic to peak—

couldn’t replicate that in drill

• Familiarity with disease, drugs, dosage, contraindications, drug information will likely improve

• Pharmacy staff need to implement appropriate infection control measures

– Resilience of staff over time could not be accounted for

– Anxiety/fear of staff and patients could not be simulated

Key Preliminary Observations

– ASTHO/NACCHO/CDC

– IEM Consulting, Inc.

– Participating pharmacies

– National Association of Chain Drug Stores

– National Community Pharmacists Association

– Rx Response

– State and Local Health officials and Emergency Management officials

– Volunteers

– Many

others!

3

Thanks to the Pharmacy

Simulation Team!

3


14/27

Harvard O inion ResearchPro ram,Februar 24- A ril 23, 2012

The Voice of Pharmacists:

A Pol l about Al ternative Methods for Antiv iralDistribution During a Pandemic Influenza

September 19, 2012

Gillian SteelFisher, Ph.D., M.Sc.

Robert J. Blendon, Sc.D.

Mandy Brule, M.A.

Harvard School of Public Health

Harvard OpinionResearch Program,February 24 - April 23, 2012

Methods Summary

41

• Mail and online poll

• Conducted February 24 to April 23, 2012

• Nationally representative sample of 1,076 Pharmacists who work in

community pharmacies (retail settings)

• Quick summary statistics on sample:

• 60% pharmacists; 38% managing pharmacists; 1% district managers

• 67% full-time (35+ hours)

• 73% staff (vs. float)

• 54% male; 46% female

• 81% married

• 37% are parents of children 18 and under

• Questions after brief description of scenario & alternative delivery effort

Technical note: Some summary statistics do not add to 100% or the sum of the subsets due to rounding and/or

categories not shown (e.g., “refused/skipped”)


Key Research Questions

42

• What do pharmacists think of this idea overall?

• Will they participate?

• What concerns might prevent them from participating?

• Do they have relevant experience that might impact

participation?

• Do they think their pharmacies will participate?

• Do they work in pharmacies that might impact their

participation?


15/27


Overarching Reactions

43


84%

85%

11%

7%

3%

5%

2%

3%

Go od Nei th er B ad Don 't Kn ow

Pharmacists’ Reactions to

Proposed Antiviral Distribution Effort

44

… a good or bad idea for the government to distribu te antivirals through

pharmacies in this way?

…a good or bad thing for th e pharmacist profession?

Just based on the information so far, do you think it would be…


Pharmacists’ Views on The Impact of This

InitiativePlease indicate whether you agree or disagree with the following statements:

Participating in this effort would strengthen…

45

28%

40%

46%

65%

78%

49%

38%

37%

28%

18%

St ron gly Agree So mewh at Agree

Relationships with your local public health department

Relationships with patients

Relationships with physicians

(93%)

(78%)

(84%)

(76%)

(96%)

The role of pharmacists during publ ic health emergencies

Relationships with your state public health department


16/27


Predictions about

Pharmacist Participation

46


47

81% 8% 6% 6%

Favor Nei ther Oppose Don 't Know

Would you favor or oppose participating in such an effort personally?

Do you think the other pharmacist(s) who work in your pharmacy would favor or oppose

participating in such an effort?

65% 4% 8% 2% 21%

Favor Neither Oppose There no other pharmacists Don't Know

Pharmacists’ Views on Pharmacist Participation


Pharmacists’ Predictions: Coming to Work for

Normal Shifts During a 12-Week Outbreak

48

How likely is it that you would come to work for your regular hours for all 12 WEEKS of the

outbreak? (Assuming you are not sick yourself)

1%

1%

6%

91%

Very li kely

Somewhat likely

Not very likely

Not at all likely


17/27


Pharmacists’ Willingness to Come In for

Extended or Additional Shifts

33%

46%

Routine Pay

Very likely

Somewhat likely

Higher Pay Rate/

Comp Time

79%

In order to support the increased prescription volume, how likely is it that you would come to work

for extended or additional shifts [at routine pay rates / if you received a higher pay rate or receivedcomp time for those shifts?

24%

67%

Very likely

Somewhat likely

49

91%


Pharmacists’ Comfort Levels in Giving Antivirals

Only to High-Risk Groups

50

In any emergency there is a chance that there would not be enough medicine at the time patients

needed it. If there were a shortage of antivirals in your pharmacy and community, how comfortablewould you be with only filling prescriptions for those identified as high-risk – following CDC

guidelines on high-risk groups?

3%

16%

41%

39%

Very comfortable

Somewhat comfortable

Not very comfortable

Not at all comfortable

80%


Concerns

51


18/27


Pharmacists’ Worries About Participating

52

Managing usual

patients

Carrying influenzaback to family

Personal exposure

to influenza

Facing antiviral

shortages

Managingantiviral patients

Keeping order

in the pharmacy

New billing

process

Personal legal

liability

11%

15%

21%

16%

19%

20%

29%

33%

33%

31%

36%

42%

40%

39%

41%

47%

Very worr ied Somewhat worr ied

(71%)

(59%)

(59%)

(81%)

(57%)

(44%)

(45%)

(58%)


Experiences that Could

Impact Participation

53


Pharmacists’ Experience Compounding

Medication

54

In the last five years, have you compounded medication to make them appropriate for children,

adults with swallowing problems or those who need special dosing?

22%

78%

Yes, I have

No, I haven’t

Don’t Know


19/27


Pharmacists’ Experience with

“Collaborative Practice Agreements”Do you personally have any experience with a “collaborative practice agreement”? (“Collaborative

practice agreement” means a written and signed agreement between a pharmacist and one ormore physicians for the purpose of medication therapy management (MTM) of patients, based on a

protocol or protocols authorized by the physician(s).)

3%

2%

58%

37%

55

Yes

No

Don’t Know-I am unfamiliar with this term

Don’t Know- Not sure if I’ve experienced this


Frequency of Contact between Pharmacists and

their State or Local Health DepartmentsIn the past year, in your capacity as a pharmacist, how many times have you had contact with any

staff of your state or local public health department?

5668%

3%

2%

6%

5%

9%

None

2

3-5

6-10

More than 10

1


Predictions about

Pharmacy Participation

57


20/27


16%

1%

82%

58

Do you think your pharmacy would participate in such a program if their really were a pandemic

influenza outbreak?

Pharmacists’ Views on Pharmacy Participation

Yes, my pharmacy would participate

No, my pharmacy would not participate

Don’t Know


79% 9% 4% 8%

Go od Nei th er B ad Don 't Kn ow

Pharmacists’ Reactions to

Proposed Antiviral Distribution Effort

59

…good or bad for business in your pharmacy?

Just based on the information so far, do you think it would be…


10%

27%

63%

Pharmacies’ Abilities to Handle 20% Increased

Prescription Volume for 12 Weeks

60

If the pharmacy only had its routine number of pharmacists, student pharmacist interns and

pharmacy technicians, do you think the pharmacy could handle 20% more prescriptions – all ofwhich were antivirals, or do you think the pharmacy would not be able to do this [for 12 weeks]?

Yes, could handl e increased volume

No, could not handle increased volume

Don’t Know


21/27


13%

72%

14%

13%

53%

34%

50%

100%

Pharmacies’ Abilities to Handle 2-3 Week Surge

of Prescription Volume

61

If the pharmacy had only its routine number of pharmacists, student pharmacist interns and

pharmacy technicians, do you think the pharmacy could handle an increase of [50% or 100%] moreprescriptions--all of which were antivirals--for 2-3 weeks, or do you think it would not be able to do

this?

Yes, could handle surge

No, could not handle surge

Don’t Know


Pharmacy Features

that Could Impact

Participation

62


Pharmacists’ Internet Access

63

While they work, do the pharmacists or pharmacy technicians have full access to the I nternet,

do they have restricted access to the Internet, do they have access to ONLY the company’s systemsoftware (intranet), or do they have no Internet or intranet access at all?

2%

32%

31%

35%

Full access to the Internet

Restricted access to the Internet

Access t o ONLY the company’s system soft ware (in tranet )

No Internet or intr anet access at all


22/27


Pharmacies’ Customer Service Options for

Patients

64

Drive-thru window

Does your pharmacy have a drive-thru

window?

Yes

No

8%

26%

34%

Yes, would be

willing to offerhome delivery

Home Delivery

In a pandemic, do you think your pharmacy

would be willing to [continue to] offer home

delivery?

Yes, continue to offer

Yes, newly offer

61%

38%


Key Take-Aways

65

• Relatively high acceptability among pharmacists

• Supportive of the effort overall

• Willing to participate personally

• Believe participation would strengthen public health role

• Pharmacy participation seems logical

• Important possible barriers to participation

• Problems with antiviral supply

• Insufficient protection for family/self

• Insufficient legal protection

• Logistical challenges

• Increasing number of staff

• Increasing Internet access

• Opportunities

• Building relationships with public health and physicians

• Sharing more perspectives: other pharmacists; executives; the public


Appendix:

Fictional Scenario

66

Please imagine for a minute that there is an outbreak of pandemic flu, where the strain

is much more severe than the 2009-2010 H1N1 outbreak, and a nationwide public

health emergency has been declared. Antivirals are most effective against this strain if

taken within 48 hours of symptoms. Commercial suppl ies are nearly exhausted and so

the government’s stockpiles are the primary source of the medication.

Unlike past outbreaks, when the government distributed antivirals mostly to public

health departments, imagine that there is a new system where the government is alsoproviding antivirals directly to pharmaceutical distributors for distribution to pharmacies.

Imagine further that your pharmacy agrees to receive shipments of antivirals and to

dispense these antivirals for patients who have a prescription. Because the new flu

virus is causing a lot of serious illness in many people, you would expect more patients

to come to your pharmacy than usual. The antivirals will be in unit-of-use (unit-dose)

packaging and will be provided to pharmacies for free from the government, but your

pharmacy can charge patients a dispensing fee. The government has established a

special claims submission process in order to ensure reimbursement for patients

without insurance. Finally, depending on the severity of the pandemic, measures will

be recommended to protect you and pharmacy staff from the virus that will reduce the

chance you will get ill and thereby reduce the chance you will infect others.


23/27

Terminology• Collaborative Drug Therapy

Management (CDTM)1

– Collaborative practice under a

protocol

– Goal: provide patient care services

that achieve optimal medication

use and patient outcomes.

• Collaborative pharmacy

practice agreement (ID)

– Agreement between 1 or more

pharmacists and 1 or more

practitioners for the purpose of

conducting drug therapy

management services

• Protocols / Standing

Orders

– Guides activities

outlined within CDTM or

separate from CDTM

(like immunizations)

– Describes nature, scope,

communication and

procedures of drug

therapy management or

patient care services

1 Source: NABP Model Act

Collaborative Drug Therapy

Management (CDTM)• Team approach

• May include, but are not limited to:

– Initiating, modifying, and monitoring a patient’s drug

therapy;

– Ordering and performing laboratory and related tests; and

– Assessing patient response to therapy.

• Authority ranges from setting/patient restrictions to broad

authority

– Non emergency

– Declared emergency

• States / Territories

with

no

CDTM

authority:

AL,

DC,

DE, OK, PR,SC

Public Health Emergency Laws

• In an emergency a state Governor can be

provided authority to issue an emergency

order to allow pharmacists to evaluate and

dispense antiviral

medications

– Some states have existing law or are proposing

specific law

– Some states go by Governor emergency

declaration ability


24/27

Approaches to Gain Authorityideally in non‐emergency situation that could apply to emergency situation

• Health Department Advocacy

• State

Board

of

Pharmacy• Washington State

– Collaborative Drug Therapy Agreement for Antiviral

Medications for Treatment or Prophylaxis during an

Influenza Outbreak.

• specifically authorizes pharmacists to prescribe antiviral medications and will only be effective when authorized by

public health officials.

• Available at

http://www.doh.wa.gov/Portals/1/Documents/Pubs/69021

3.pdf

CDTM

• For pharmacists to engage to the full extent in dispensing antiviral medications, CDTM laws

need to be structured to allow pharmacists to

evaluate a patient per a protocol and order an

antiviral medication for that patient.

– Not to be confused with prescribing

• These medications have a time factor for

receiving maximum benefit


25/27

Broad or Open‐Ended Language• Use permissive language

• Types of collaborative authority decisions, including:

– types of diseases, drugs, or drug categories involved and the type of

collaborative authority authorized in each case; and

– procedures, decision criteria, or plans the pharmacists are to follow when

making therapeutic decisions, particularly when modification or initiation of

drug therapy is involved;

• Offers an opportunity for pharmacists to evaluate a patient per a

protocol and order an antiviral medication for patient seen under

the CDTM.

CDTM laws that may hinder ability of

pharmacists to order antiviral therapy

• Requirement for a Prescriber’s Initial Diagnosis

of the Patient

• Requirement for a Physician Order for Therapy

for a Specific Patient

• Requirement that CDTM Take Place in a

Hospital or Similar Facility

• Requirement that the Pharmacy Have a

Private Setting for CDTM

Recap

• Be prepared before an event occurs

• Serve the public health needs of communities

• Have

the

service

be

a

part

of

the

services

provided by the pharmacy

– Time is essential for effectiveness of the therapy


26/27

Self ‐Assessment Question #11. The purpose of exploring a new method of

pandemic antiviral distribution and dispensing is

to:A. Improve access to antivirals during an influenza

pandemic

B. Increase the burden on public health during a

public health emergency

C. Provide antivirals for free to the public

D. Ensure every American has a dose of antivirals


2. CDC’s pharmacy simulation exercises provided

information that:

A. Pharmacies can provide medicines during an

emergency

B. Pharmacies can increase the number of patients

served during a future pandemic

C. Usual standards of accuracy and quality control

can be maintained when dispensing antivirals

during a pandemic

D. All of

the

above


3. Collaborative Drug Therapy Management

(CDTM) encompasses the following:

A. It is a team approach

B. May

include,

but

is

not

limited

to

initiating,

modifying, and monitoring a patient’s drug therapy

C. Can be utilized in non‐emergency and declared

influenza situations

D. All of the above


27/27

May, 2011 May, 2013

9/19/2012

Project Plan for CDC Alternative Antiviral Distribution and

Dispensing Project

If the proposed strategy is feasible and acceptable…

Fall 2012

• CDC develops, issues, receives RFP s and evaluates them for

feasibility, suitability, practicality and acceptability

• CDC will finalize new approaches and award contract to entities

• CDC will develop SOPs, amend state planning guidance, and

working with ASTHO and NACCHO, disseminate final plans to

SLTT partners

Questions??

How to Obtain your CPE Credit

• Record Attendance Code provided during the webinar

• Please visit: http://www.pharmacist.com/live ‐activities

and select the Claim Credit link for this activity

• You will need a pharmacist.com username and

password

• Select Enroll Now or Add to Cart from the left

navigation and successfully complete the Assessment

(select correct attendance code), Learning Evaluation

and Activity Evaluation for access to your statement of

credit. You will need to provide your NABP e‐profile ID

number to access your statement of credit.