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Assisting patients during national disasters
Jamila Negatu
/ Categories: Student Magazine

Assisting patients during national disasters

By the 2018–19 APhA–ASP Policy Standing Committee

According to the Federal Emergency Management Agency, in 2017, there were 137 natural disasters declared in the United States, 59 of which President Trump classified as a major disaster. In the same year, the Internal Displacement Monitoring Centre estimated that more than 1.6 million Americans were displaced by natural disasters alone.

The largest portion to this staggering displacement statistic included major hurricanes named Harvey, Irma, and Maria, with almost two-thirds of that estimate. People displaced by natural disasters face many obstacles and challenges during evacuation. It is important during those difficult times that medical needs are not neglected. 

The 2018 APhA–ASP House of Delegates took action on this important issue in March, passing the following: 

2018.3 – Emergency Prescription Refill Protocol

APhA–ASP encourages state boards of pharmacy to develop a standardized protocol allowing pharmacists to provide refills, not pursuant to a prescription, during a declared state of emergency, natural disaster, or man-made disaster. 

APhA–ASP encourages state boards of pharmacy to promote awareness and competencies of all pharmacy personnel regarding standardized protocols.

Insurance obstacles

With CDC estimating that one-half of Americans take prescription medications, hundreds of thousands of Americans can lose access to their medications from a single natural disaster. In addition to the health consequences of losing access to medications, there are also the financial consequences. Patients must find other facilities to fulfill their medical needs when they are unable to obtain their medications due to geographical challenges, lack of refills, or prescriber unavailability. 

Patients often turn to urgent care centers or emergency departments, either to obtain a simple refill or to treat a condition that requires more pressing medical treatment due to the lack of prescription medications. If a patient tries to prepare for a disaster by refilling their medication early, there is the question if their insurance company will cover an early refill of a medication. Fortunately, there are available policies and programs to assist those affected by a disaster. 

The Emergency Prescription Assistance Program (EPAP) allows pharmacies to dispense refills of prescription medications to uninsured patients affected by disasters. The requirements for participating in this program include: the pharmacy must be registered with EPAP, the patient must be uninsured, reside in a federally identified disaster area, and be able to prove they have an existing prescription. A current prescription bottle is suitable as proof of a current prescription. EPAP is also able to provide select medical equipment and vaccines if needed by the patient. 

While this program makes strides to assist displaced patients, it is limited to those without health insurance. Assistance is still needed for patients when their refills and primary providers are unavailable, regardless of their insurance status.

On the state level

The state of Florida requires that health insurers waive the time restrictions on refilling prescription medications if a patient lives in a county under a state of emergency or hurricane warning. This allows patients to obtain a 30-day supply of their medications prior to evacuation without worry of payment. This protocol also enables pharmacists to authorize a refill order for the medication and notify the prescriber afterwards. But not every state has the same protocols as Florida. 

As of 2014, eight states allow emergency refills of at least 30 days, 15 states do not allow emergency refills, and many of the remaining allow only 72-hour refills. The intent and use of these 72-hour protocols are mainly for continuity of care and not for disaster response. Sometimes there are conditions to the emergency refill as well, such as in Ohio, where the pharmacy must have been previously used by the patient. While many of the states with expanded emergency refill protocols are those affected by hurricanes, natural disasters could affect any area of the United States at any time of the year. Patients may also end up suffering from less generous protocols if they evacuate to states with more restrictions on emergency refills.

Standardized protocol needed

As encouraged by the APhA–ASP policy, having a standardized protocol across all states for emergency refills would protect people displaced across state lines. In addition, it would provide potential crucial assistance to every American in the case of an unexpected natural disaster. Existing protocols and programs such as EPAP are only 
effective within their limited reach and requirements. 

Encouraging states to adopt a standardized protocol allowing pharmacists to authorize refills during a state of emergency can help prevent the increase of health care costs as well as ensuring patient outcomes remain optimal.

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