A coalition of pharmacists is pushing the federal government to allow them to test and initiate treatment for COVID-19 patients. 

A dozen pharmacy organizations released a joint set of policy recommendations aimed at addressing the coronavirus pandemic last week. About 400 Americans had died from and more than 30,000 had tested positive for COVID-19 as of Sunday evening. 

The pharmacists want to be able to order, collect specimens, conduct and interpret tests and, when appropriate, initiate treatment for infectious diseases. This would include COVID-19, flu and strep. They also want to be allowed to interpret and discuss results with patients. 

They also want to expand current state pharmacists immunization authority to include all Food and Drug Administration-approved vaccines, including any forthcoming vaccine for novel COVID-19. 

“With 90% of Americans living within [five] miles of a community pharmacy, pharmacists are positioned to serve on the front lines and are able to help. They are medication experts, providing patient care in a variety of settings, including hospitals, clinics, community pharmacies, long-term care, the medical home, and physician offices,” the coalition wrote. 

The letter writers also recommend allowing licensed pharmacists and pharmacy technicians to operate across state lines, conduct therapeutic interchange and substitutions without physician authorization when a shortage arises, and provide coverage for services delivered by pharmacists if they are within the scope of practices and coverage for other healthcare providers. 

“Action on the following [these] policy areas will empower pharmacists to fully and effectively support our nation’s COVID-19 response and help to ensure patients get the treatment they need,” the groups stated. 

The coalition is composed of 12 pharmacist advocacy groups, including the American Society of Consultant Pharmacists, American Pharmacists Association and American Association of Colleges of Pharmacy. 

‘Unchartered territory’

The majority of experts believe that the source of the pandemic is not a seasonal virus, meaning social distancing is needed to decrease its exposure-doubling rate from about five to six days to something more like 20. That’s according to Troyen A. Brennan, M.D., M.P.H., the Executive Vice President and Chief Medical Officer of CVS Health, during a McKnight’ s Long-Term Care News Online Expo webinar on Thursday.

“Through that process, we are trying to reduce the damage it can do in the healthcare system. If too many people get it at the same time, the hospitals get overwhelmed,” he explained.

“It’s not different from a lot of viruses, other than it’s traveling relatively fast and it has a higher mortality rate,” he said adding that a lot of COVID-19’s characteristics are not fully understood. “We’re in unchartered territory.”

More pharmacy advice

Lockdown precautions are important for facility residents, as well as staff and other service providers who support them, said Nancy Losben, a consultant pharmacist and Senior Director, Quality Long Term Care for Omnicare, a CVS Health company, who also spoke at the Online Expo session titled “Understanding and addressing COVID-19.”

“Facilities should also be limiting unnecessary onsite visits from pharmacists, consultant pharmacists, pharmacy account managers, consultant nurses and infusion nurses — unless the infusion nurse has a skill or service that you cannot provide yourself,” Losben said. She urged SNF clinical staff to closely look at any relatively minor clinical conditions. “You may be able to avoid the discharge of a resident to an overtaxed hospital when you just have a bacterial infection that you may easily manage, to avoid that transfer to the hospital, thereby eliminating further exposure of those very precious residents.”

Good planning, and then open communication when a COVID-19 infection or exposure to it is discovered, are musts, she emphasized.

“A pharmacy driver may have many facility stops on their list, so consider a single location for pharmacy couriers to deliver to and for you to receive your medications,” Losben counseled. “After all, you would not want your couriers moving from one area to another after being in several other facilities. For signing for deliveries, as most nurses do, use your own pen. If have to use an electronic device to sign for any deliveries, even if from UPS or any delivery agent, use gloves or wipe the device with a disinfectant and wash your hands afterward.”

Pressure to find enough personal protective equipment wherever possible is critical, especially for ancillary service providers who are deemed essential.

“Having the PPE available on the floor is [important], if you have it. It is NOT obnoxious to ask the healthcare provider to bring their own,” she added.

A different kind of risk

In other related news, COVID-19 has interrupted everything from travel to dining to daily living in some states. Even though COVID-19 has put many plans on the backburner, that should not necessarily be the case regarding institutional special needs plans, or I-SNPs. 

Catherine Murphy-Barron, principal and consulting actuary in the New York office of Milliman, said that providers interested in joining I-SNPs, which are Medicare Advantage insurance models, may still want to forge ahead. 

“The virus is one of those events that happens rarely but can have a detrimental impact on an organization,” said Murphy-Barron during a McKnight’s Online Expo session she led on Thursday. “It highlights why states have capital requirements for all payers, including I-SNPs, so they can weather these situations.

“For providers thinking of sharing risk with a payer, I don’t think they should think of this as a reason not to move forward, but rather as a reminder to examine the details of the proposed contract and look for reinsurance protection for just such random unexpected events,” she continued.