Best of Pharmacy Focused Efforts 

Drug Shortages and Stockpiling

Best Practice: CPESN Network developing a list of pharmacies with COVID-19 related medications in stock

  • Volunteer to lead this initiative within a local CPESN Network (or group of pharmacies), like Steve Osenbaugh (RelyCare Pharmacy) did with NESP (Nebraska CPESN)

  • Upload the templated Google Spreadsheet to Google Docs, share with pharmacy group and have everyone update inventory totals (NESP pharmacies doing once weekly on Wednesday)

    • Minimally include hydroxychloroquine stock. If azithromycin or other meds are added as COVID-19 related, add new drugs to list of inventory

      • Be sure the document is editable (not view only)

  • If a patient or hospital requests a drug that is on shortage and the drug is prescribed for a legitimate indication, pharmacies can view the Google Doc that was created to see which pharmacy has it in stock

    • Goal: Connect patients / hospitals with pharmacies with the medication in stock

Best Practice: Develop a Protocol for your pharmacy on how to handle shortages

  • Create a protocol for how to best handle hydroxychloroquine shortages for your pharmacy and determining which patients are in most need for these drugs

  • Talk with local prescribers to inform about the drug shortages and discuss alternative options for patients on medications for chronic conditions

  • Discuss your with local hospital(s) and determine their need for the COVID-19 related drugs, in case they are in need for a drug to be supplied by the pharmacy.

    • Utilize the spreadsheet mentioned above to help with connecting hospitals with pharmacies in the area if needed.

  • Stay up to date with ASHP's guidance on Drug Shortages (see info further down page)

Best Practice: Remain Current on Drug Shortages

  • Bookmark AHSF Drug Information® - Open access for 60 days effective 3/16/2020

  • On the tabs, click "Shortages" to view:

    • Medications that are on shortage​ and the reason

    • Manufacturers that are continuing to supply

    • Estimated resupply dates

    • Implications for patient care

Best Practice: Managing the Drug Supply Chain

  • Ensure that you are optimizing/maximizing your medication synchronization program including enrolling patients who are at high risk if COVID-19 is contracted

  • Monitor your primary and secondary wholesalers for supplies of critical medications for your patients, especially those at risk with chronic conditions

    • Ensure you have a sufficient quantity of critical medications in your pharmacy to cover your patients for at least the next 30 days

Best Practice: Be the steward for appropriate use of medications in your community

  • Ensure that medications that have “potential” benefits for COVID-19 treatment (e.g. hydroxycholoroquine, azithroymycin, etc) are first being reserved for your patients using them for proven therapeutic effects (e.g. RA)

    • Patients taking hydroxychloroquine for a chronic condition, consider talking with the prescriber for alternate therapy and/or limit to a 30 day supply​ or less

  • Follow your region/state/board recommendations as to rationing quantities

    • Example from Arkansas in link to the left.

  • Discuss further with prescribers who are ordering quantities for self-use

  • Know and understand the current use of these medications for “off-label use” so you can be a resource for your patients, prescribers, and other stakeholders

    • CDC Therapeutic Options: Click here

      • Although optimal dosing and duration of hydroxychloroquine for treatment of COVID-19 are unknown, some U.S. clinicians have reported anecdotally different hydroxychloroquine dosing such as: 400mg BID on day one, then daily for 5 days; 400 mg BID on day one, then 200mg BID for 4 days; 600 mg BID on day one, then 400mg daily on days 2-5.