Updates to Community Pharmacy Practice Due to COVID-19

Quality Corner April 28, 2020

The novel coronavirus (COVID-19) pandemic has made a significant impact on the way of life in the United States and around the world. With non-essential businesses being forced to close down to encourage social distancing, people have had to adapt to this “new normal” as the search for both prevention and treatment options are underway. So how did this affect pharmacies and their staff? As an essential part of the healthcare team and communities nationwide, pharmacies must remain operational in situations like these.

To ensure that pharmacists and their teams stay healthy and are able to serve their patients, many organizations have provided guidelines and best practices to help keep pharmacy staff and their patients safe. One such entity is the Centers for Disease Control and Prevention (CDC). Some of their recommendations can be found below:

Not feeling well? Stay home!
- Advise pharmacy staff who are exhibiting symptoms of a respiratory infection or those running a fever to stay home
- Management have been encouraged to be flexible and non-punitive with regard to their sick leave policies
Ensure hand sanitizer is readily available for patients and staff to use after completing transactions
- Hand washing is preferred when reasonable to do so
- USP guidance and formulations for compounding hand sanitizer can be found here
Prescribers should be encouraged to submit new prescriptions electronically or via telephone
- Avoid handling insurance cards or other patient information if at all possible
Engineering controls to enhance social distancing should be used
- Signage and barriers should be used to ensure proper distance between patients and staff
- Plexiglass or clear plastic shields with a small opening for exchange of materials should be installed at patient contact areas, if feasible
- Discontinue use of magazines and shared items in patient waiting areas
Administrative controls should also be utilized
- Where possible, patients should be encouraged to utilize curbside pickup, drive-thru, and home delivery services
- Whenever possible, pharmacists providing counseling should be encouraged to utilize telephone, telehealth, or telepharmacy services, unless the counseling would be better performed face-to-face

On April 8, 2020, guidance was provided that licensed pharmacists were authorized to order and administer FDA-authorized COVID-19 tests, including serology tests. This was based on the Public Readiness and Emergency Preparedness (PREP) Act declaration on March 10, 2020.

HHS Secretary Alex Azar’s statement:
“Giving pharmacists the authorization to order and administer COVID-19 tests to their patients means easier access to testing for Americans who need it. Pharmacists play a vital role in delivering convenient access to important public health services and information.”

[pullquote]Opportunities for testing may exist – be sure your pharmacy is looking to CLIA certificate waivers to be prepared and help support testing and claims at the pharmacy.[/pullquote]

Pharmacists will be considered “covered persons” under the PREP Act and are given immunity with respect to all claims for loss caused by, arising out of, relating to, or resulting from, the administration or use of FDA-approved tests However, the guidance does not speak to or change any reimbursement policy for test administration.

Need to fill out and submit a CLIA Certificate of Waiver (aka “CMS Form 116”) in order to provide this test? More information can be found here: https://www.hhs.gov/sites/default/files/authorizing-licensed-pharmacists-to-order-and-administer-covid-19-tests.pdf.
This link walks through the process of obtaining a CLIA Waiver https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads/HowObtainCertificateofWaiver.pdf and the link to the CLIA Waiver form can be found here: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS116.pdf
Note that there are still lots of unknowns currently regarding reimbursement for COVID-19 testing. As soon as this blog post is published there may be a new guidance related to this so be on the lookout from the CDC and specific Health Plans for more information for different patient populations, such as private and government-based insurance.

In several states, there have been changes that have been made to ease the burden that may be associated with meeting the needs of patients while maintaining safety of both employees and patients alike. Here are a few changes that have occurred at this point:

The pharmacist-to-technician ratio has been temporarily suspended. There is no restriction on number of technicians per pharmacist while order is in effect.
Emergency fills and extended day supplies: pharmacists may authorize refills on maintenance medications up to 90 days (not including controlled substances).
Remote verification: pharmacists and pharmacy technicians may complete remote computer-based processing of prescriptions at alternate locations just so long as personal health information (PHI) is secured appropriately.
Waiver of the signature requirement when picking up prescriptions.
Increase the focus on delivery as options of providing medications to patients

Community pharmacies are the front-line healthcare providers in the United States. Please be safe by following the recommendations from the CDC regarding both pharmacy staff and customers wearing facemasks and continue to talk care of the patients you serve.

While this is a challenging time, there are opportunities for community pharmacies to step up and show everyone the important role they play in the health and wellness of their communities. Being creative in working with your patients during this time, using tele-health (counseling via video chat), curbside delivery, compliance packaging, or other ideas that reduce the amount of visits a patient physically makes while still keeping their health in mind during this time will be important moving forward. These ideas can both increase the connectiveness of patients have with their pharmacies and potentially improve adherence rates to their chronic medications if all fills are billed through their appropriate insurance. Stay safe and thank you for all you do to serve the lives of the patients you serve!

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