Coronavirus update

OPA has been working around the clock maintaining your membership services, fielding calls and questions from members, rescheduling our Annual Conference, and engaging media and state officials in an effort to help deploy strategies to protect Ohioans from the spread of COVID-19.

As we field feedback from our member pharmacists on the ground, we are assessing all suggestions, opportunities, and concerns, and we are pushing them to officials at the governor's office, board of pharmacy, department of health, health plans, and other state leaders.

We are pleased to report that much of our feedback and recommendations are being embraced, and much of it is in the process of being implemented, if not already. And we are continuing to refine and build our strategies for success — much like all of you are doing back at your practices and in your homes.

First, this week we have launched a special section of our website dedicated to COVID-19 news and resources. We plan to update with any and all relevant information. In the interest of serving the profession and the public, we have made this open to all members and non-members alike. Please bookmark it and check it often.

The Ohio Department of Health has created a special checklist of the top 10 things pharmacies can do prepare for and protect from COVID-19. They also created a general guide for businesses and employers.

Second, we have been pushing state officials for emergency guidance and policy changes to help better equip pharmacists and pharmacy staff with they tools they need to protect themselves and the public. Here is a rundown of the latest:

• March 13: Pharmacies empowered to perform remote prescription processing
  This ensures that workflow can be better managed by off-site personnel for pharmacies, keeping administrative functions outside of the pharmacy area.
• March 14: Pharmacists empowered to compound hand sanitizer
  As hand sanitizer supplies are diminished, many pharmacies struggled to keep their pharmacies clean and to offer needed supplies to their patients. Recognizing that pharmacists can compound sanitizer from scratch, OPA worked with the board to create a temporary allowance for pharmacists to compound their own alcohol-based sanitizer for their own use and distribution to the public.
• March 14: Allowing reuse of Personal Protective Equipment (PPE) for compounding activities
  Recognizing the diminished supply of PPE, and the need to conserve needed supplies, the board has created new allowances for sterile compounders to reuse certain types of PPE.
• March 16: Extending and expanding pharmacists' authority to dispense emergency refills
  With many patients and pharmacists having difficulties obtaining reauthorizations of current drug therapy from prescribers, OPA worked with the board to expand emergency dispensing authority. Specifically, the guidance allows the following:
  • Extends the emergency refill of schedule III-V controlled substances to not exceed a thirty-day supply or the days’ supply as indicated in the pharmacy’s records, whichever is less (as opposed to a 72-hour supply limitation).
  • Permits a pharmacist to authorize emergency refills for a particular drug up-to three times
    in any twelve-month period (as opposed to once in any twelve-month period). This applies to both schedule III-V controlled substances and non-controlled substances.
  • In lieu of three 30-day emergency refills, a pharmacist may dispense a one-time emergency refill of a 90-day supply for a particular non-controlled substance medication.
  • The board also authorized the use of oral prescriptions for schedule II controlled substances as
    permitted in 21 CFR 1306.11(d).
• March 16: Empowering compounding pharmacists to step in to address drug shortages
  As the drug shortages mount, the need for pharmacists to get pragmatic with drug supply grows. Recognizing this, OPA worked with the board to unleash the expertise and skills of Ohio's compounding pharmacists to help fill the void of drugs that are in shortage.

OPA is currently evaluating and pursuing a number of other suggestions and requests, including:

• Removing PBM/insurer requirements for patient signatures
• Disallowing PBMs from placing restrictions on pharmacy mailing of prescriptions
• Creating a formal assessment and referral process for pharmacists encountering symptomatic patients
• Securing PPE for pharmacies encountering high-risk patients without the ability to maintain safe distances
• Easing pharmacy technician registration requirements
• Allowing pharmacists to dispense emergency medications without a prescription
• Disallowing restrictive pharmacy networks and single-source provider agreements for durable medical equipment
• Allowing pharmacists to test and treat for CLIA-waived tests for flu and strep
• Removing "refill too soon" limits from PBM and insurers
• Allowing therapeutic substitution for drugs that are out of supply or in shortage
• Obtaining reimbursement for delivery services
• Allow insurance coverage for pharmacist-initiated OTC products
• Ensuring compounded shortage drugs are covered by insurers/PBMs
• Obtaining reimbursement for pharmacist-rendered services (consult agreement drug therapy management, INRs, etc.) to relieve pressure on health systems and emergency departments
• Moratorium on PBM audits and DIR assessments
• Implementing Medicaid supplemental dispensing fees

These are just a few of our suggestions, but we are open to hear many more. If you see any opportunities or concerns that you feel need to be addressed, please contact aciaccia@ohiopharmacists.org. 

Lastly, we are fielding a lot of phone calls and emails from pharmacists and pharmacy staff raising concerns about a lack of adequate stock of protective equipment, cleaning supplies, and resources for pharmacy team members that could increase the risk of germ spread to pharmacy staff and patients. We have raised these issues with the board of pharmacy and governor's office, and the board has put out guidance addressing the practice of pharmacy in a safe and effective manner. Please share with your colleagues, managers, and employers.

If you feel that your pharmacy is not taking adequate measures to maintain safe distancing between staff and and patients, provide for a clean practice setting, or provide reasonable amounts of protective equipment (recognizing the shortage of PPE), please keep us informed, and let the board of pharmacy know as well. We have heard of some managers disallowing pharmacy staff from wearing their own protective equipment, from propping up distancing mechanisms, and from not allowing sick staff to go home. While it will be tough to obtain perfection in the current environment, these stories from the trenches are unacceptable.

A reminder to all pharmacists: it is your license, and if you feel that someone is unreasonably getting in the way of the safe practice of pharmacy, it is important to speak out. We will be working to make sure your voices are heard.

Stay tuned, and stay safe. OPA will continue working for you while you continue working for your patients.

And now, for the news...

Top News

Pharmacists, patients are stuck in the middle of a profit-before-all-else pharmacy racket
STAT News
OPA member Scott Knoer nails it: "The news that chaos reigns inside chain pharmacies, putting patients at risk, may have come as a shock to readers but it’s no surprise to any pharmacist, pharmacy technician, or pharmacy student, all of whom know that the system is broken. Ellen Gabler’s exposé in the New York Times showed how big chain pharmacies sacrifice patient safety by placing unreasonable volume and speed demands on pharmacists. It highlighted how pharmacy staff are under-resourced, over-worked, and discouraged from speaking out about conditions they feel are putting patients in harm’s way. Intense financial pressure combined with the volume-based reimbursement that drive the constant push for more pills are compromising patient care and pharmacist well-being."

50 confirmed coronavirus cases in Ohio in 12 counties
News 5 Cleveland
There are now 50 confirmed cases of coronavirus in Ohio in 12 counties, according to a Monday afternoon update from the Ohio Department of Health. The total number of cases rose from 37 Sunday. Cuyahoga County remains the county with the highest number of cases in the state with 24. There are 6 in Butler, 2 in Belmont, 3 in Franklin, 1 in Geauga, 3 in Lorain, 1 in Lucas, 1 in Medina, 3 in Stark, 2 in Summit, 2 in Trumbull and 1 in Tuscarawas. There are currently 14 coronavirus hospitalizations in Ohio.

State task force tackling high prescription drug costs
Columbus Dispatch
As Ohio continues to combat skyrocketing prescription drug costs, a new panel of government, business and consumer advocates has begun exploring ways to provide greater price transparency and ensure that potentially lifesaving medications are affordable and accessible. The Prescription Drug Transparency and Affordability Advisory Council met for the first time this month, tasked with making recommendations to Gov. Mike DeWine and state legislators by June 30.

Citing health emergency, Ohio officials to order polls closed on Election Day, despite judge’s ruling
Cleveland Plain Dealer
Ohio Gov. Mike DeWine announced late Monday that polls will be closed on Tuesday for the presidential primary election, citing a “health emergency" tied to the ongoing coronavirus pandemic. DeWine’s statement, issued Monday at 10:12 p.m., reads in full: “During this time when we face an unprecedented public health crisis, to conduct an election tomorrow would force poll workers and voters to place themselves at a unacceptable health risk of contracting coronavirus.”

Editorial: Transparency is key to lower drug prices
Columbus Dispatch
To tame ever-rising prices for prescription drugs in Ohio, most observers have a similar idea on how to do it, and it’s right in the name of a new task force that began meeting recently: The Prescription Drug Transparency and Affordability Advisory Council. We agree that greater price transparency for drugs is essential to a saner health care system, but we hope the new panel also will consider a broader fix: getting rid of pharmacy benefit managers. The private companies serving as middlemen between drug companies and the private companies who handle the state’s Medicaid program have profited immensely by draining hundreds of millions of dollars from the taxpayer-funded system. The value they have provided hardly seems worth the cost.

How coronavirus is limiting drug exports from India, China
Cleveland Plain Dealer
India announced restrictions on exports of 26 drugs and drug ingredients because of COVID-19, but officials don’t yet know how much additional stress the move will place on already strained supply lines. The spread of the novel coronavirus in China that shuttered factories and airports already placed strain on pharmaceutical supply lines in recent weeks. India is hoping that the new restrictions on exports will prevent any medicine shortages within the country; pharmaceutical companies source about 70 percent of their ingredients for drugs from Chinese factories, The Guardian reports.

Untangling a maze of drug pricing terms
Spectrum 1 News
Antonio Ciaccia, Director of Government and Public Affairs for the Ohio Pharmacists Association, sheds some light on the supply chain of prescription drugs from the drugmaker to the consumer, and explains how pharmacy benefit managers (PBMs) work.

Yost joins bipartisan coalition in defending states’ rights to regulate rising cost of prescription drugs
Office of Ohio Attorney General Dave Yost
Ohio Attorney General Dave Yost joined a bipartisan coalition of 46 attorneys general supporting states’ rights to regulate and address the rising cost of prescription drugs. In an amicus brief to the U.S. Supreme Court, the attorneys general support Arkansas’ position in Rutledge v. Pharmaceutical Care Management that regulation of the prescription drug market, including pharmacy benefit managers (PBMs), is a critical tool for states to protect residents and address the access and affordability of prescription drugs. They contend that state laws regulating pharmacy benefit managers are not restricted by federal law.

^QUOTABLE^
"Ohio will not give up its duty and right to protect its citizens to some federal bureaucrat in Washington, D.C."

Hospitals working to end elective surgeries as coronavirus looms
Columbus Dispatch
All Ohio hospitals are working to end elective surgeries on Thursday and turn their sights on the coming spike in COVID-19 cases, the medical director of one of the state’s largest health systems said Monday. Currently, 50 Ohioans have tested positive for the new coronavirus. But some doctors are concerned that in eight to 10 days, the U.S. health system will be hammered on a scale similar to that of Italy, where doctors in some cases were forced not to treat the oldest, sickest patients. OPA member Nnodum Iheme discusses how sick patients are walking into pharmacies, but that a lack of available protective equipment is raising concerns.

March 18: Community Pharmacy Working Conditions Study
Purdue University
What are the working conditions like in community/retail pharmacies?  A research team from Purdue University is researching community/retail pharmacists’ working conditions and pharmacists’ suggestions to improve work conditions.

Congratulations to the states making strides toward provider status
American Pharmacists Association
According to the National Alliance of State Pharmacy Associations (NASPA), 34 states considered 109 provider status recognition bills in 2019. I’m blown away by the work state pharmacy associations are doing to advance and raise the profile of policies that increase patient access, promote team-based care, gain recognition and coverage for pharmacists’ patient care services, and ultimately reduce costs for the entire health care system.

OPA News

OPA Annual Conference rescheduled for August 28-30, 2020
Ohio Pharmacists Association
After direction from Governor DeWine's office, the leadership of the Ohio Pharmacists Association has made the difficult but necessary decision to reschedule OPA's 142nd Annual Conference & Trade Show due to COVID-19. We extend our gratitude to our members, attendees, speakers, sponsors and exhibitors for their understanding and for their commitment to the success of this Conference. The OPA Annual Conference & Trade Show will be held August 28-30, 2020 at the Greater Columbus Convention Center in downtown Columbus.

2019 OPA Salary Survey Results
Ohio Pharmacists Association
Do pharmacists' salaries vary from one part of Ohio to another? Could you earn more money in a different practice setting? This information is available exclusively to OPA members.

Employer-Based Pharmacy Technician Training Programs offered
Ohio Pharmacists Association
Are you an employer who needs to train technicians and wonders how to meet the board of pharmacy requirements for an employer-based training? OPA now offers two Employer-Based Pharmacy Technician Training Programs for purchase by a pharmacist.

Want to be engaged with Provider Status? Take the Ohio Pharmacy Services Survey.
Ohio Pharmacists Association
Have you ever wondered what different clinical services hospital pharmacists provide versus community pharmacists? Do you want to be involved with implementing Provider Status in Ohio? Find the answers to these questions and start engaging with Provider Status by participating in the Ohio Pharmacy Services Survey.

March 20: Applications for NPX Advisory Team Due
Ohio Pharmacists Association
If you are within 7 years of graduation, your OPA membership gives you access to the New Practitioner Experience (NPX), which is a group for all new practitioners to help you achieve personal and professional success. NPX is currently looking for interested individuals to take active leadership roles on the NPX Advisory Team. 

May 13: APhA’s The Pharmacist & Patient-Centered Diabetes Care Certificate Training Program
Ohio Pharmacists Association
This program is an educational experience designed to equip pharmacists with the knowledge, skills, and confidence needed to provide effective, evidence-based diabetes care.

Ohio Pharmacy News

New Board of Pharmacy rules proposed
State of Ohio Board of Pharmacy
The State of Ohio Board of Pharmacy values the input of all stakeholders in the regulatory process and encourages your participation in the rule revision/development process. Below you will find information on rules currently being proposed by the Board.

In this section you will find rules, including public hearing notices, currently under the review of the Joint Committee on Agency Rule Review:

• Public Hearing 4.10.20
• Public Hearing 3.27.20

If you have any comments or concerns on the above rule proposals, please email Antonio Ciaccia at aciaccia@ohiopharmacists.org. 

Pharmacist prescribing of naloxone improves access to life-saving medication
American Pharmacists Association
The number of naloxone orders dispensed in Ohio surged by 2,328% after the Ohio General Assembly approved a law in 2015 allowing pharmacists to dispense naloxone without a prescription, according to a recent study in JAMA Network Open. With prior studies estimating a 14% reduction in death by opioid-related overdose in states where access to naloxone is increased, the findings are significant.

French warn against anti-inflammatory drugs to treat coronavirus; Cleveland doctor wants more data
Cleveland Plain Dealer
The French health ministry is warning against the use of anti-inflammatory drugs, such as ibuprofen and cortisone, to treat symptoms of the coronavirus, but one Cleveland-area doctor would like to see more data before drawing any conclusions. The Guardian reported Saturday that the French health minister, Olivier Veran, tweeted that taking the anti-inflammatories like Advil and Motrin “could be a factor in aggravating the infection. In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.”

Drugstores beg shoppers to stop hoarding
WCPO Cincinnati
First it was face masks that disappeared after a run on stores by nervous consumers. Now it's hand sanitizer and any type of disinfecting wipes, leaving pharmacists begging people to stop hoarding. Pharmacist Troy Stinson says his store, Mullaney's Pharmacy, ran out of masks weeks ago, and has no idea when more may come in. Now hand sanitizer has become the new N95 face mask: almost impossible to find, after hoarders came in and cleared the shelves.

'We’re basing this on science': Ohio emerges as leader in U.S. coronavirus response
Cincinnati Enquirer
Students won't be in classrooms next week. Prominent sports events from March Madness to the Masters have been canceled or postponed. Churches and synagogues are live-streaming services. Life as we know it has changed in America. And it's changed, in large part, because of Ohio. The Midwestern state has been leading the nation's response to COVID-19, the infectious disease caused by the novel coronavirus. While President Donald Trump was slow to shut down public events, including the Republican's own campaign rallies, Ohio Gov. Mike DeWine's administration imposed the nation's most restrictive ban on large gatherings. He then closed all schools for at least three weeks.

Mount Carmel, pharmacists reach settlement with state regulators in Husel case
Columbus Business First
Mount Carmel Health System and two pharmacists have reached settlements with the Ohio Board of Pharmacy, closing its investigation into deaths of patients under the care of a fired intensive care physician.

Health system specialty pharmacy: benefits to oncology prescription turnaround times
Pharmacy Times
Oral oncology medications offer tremendous new cancer treatment options. However, in many cases, it is a significant logistical challenge to get these medications to patients in a timely manner. Prior authorization (PA) requirements, cost, and other factors can lead to turnaround times of up to 3 weeks,1 delaying the start of therapy and creating substantial anxiety for patients. Providers from Summa Health, an integrated health system based in Ohio, note both the emotional and the physical implications of a cancer diagnosis. Excellent work being done by OPA members Stuart Deal and Megan Johnson!

Amy Acton is calming leader in coronavirus crisis
Columbus Dispatch
Amid the increasing fear and confusion of the coronavirus pandemic, a voice of knowledge reassures Ohioans every day. At daily live-streamed press briefings, Dr. Amy Acton follows Gov. Mike DeWine’s announcement of orders and restrictions with calm explanations of outbreaks and community spread. Speaking candidly but calmly, the director of the Ohio Department of Health translates complex medical theory to plain English, then immediately lets her humanity shine through.

Cleveland Clinic, University Hospitals to begin testing in-house for coronavirus
Cleveland Plain Dealer
The Cleveland Clinic and University Hospitals soon will begin testing patients for the novel coronavirus, known as COVID-19, in-house. Both local hospital systems have ordered tests and purchased reagents — substances or compounds added to a mixture to see if a reaction occurs — to validate those tests, according to hospital officials. Validation means performing experiments on the tests to ensure they will give correct results, said Andrea Pacetti, a Clinic spokesperson.

FDA monitors potential medication shortage due to coronavirus
WDTN Dayton
The FDA says they are keeping close watch of medications. Much of the ingredients used to make them are manufactured in China. The FDA says one manufacturer has already reported a shortage of one medication. They are not identifying which medication it is at this point. 

Pharmacies run out of hand sanitizers
Sidney Daily News
Fears of the new coronavirus have caused local pharmacies to run out of hand sanitizers and facial masks, and businesses of all kinds have increased precautions as they attempt to slow the spread of the virus. OPA member Alison Haas, a pharmacist and owner of Jackson Pharmacy & Wellness Center in Jackson Center, said her business ran out of both hand sanitizers and facial masks earlier last week. Manufacturers indicated the pharmacy might get some next month, Haas said, but she thinks that’s unlikely as hospitals and health care workers likely will receive available supplies. Bunny’s Pharmacy in Sidney ran out of masks a couple weeks ago and ran out of hand sanitizer last weekend, OPA member Greg Bonnoront said.

Legacy of first black woman to graduate from pharmacy lives on
Pittwire
In the 1916 edition of the University of Pittsburgh’s yearbook, “The Owl,” Ella P. Stewart’s inscription reads: “(She) can be distinguished by her wisdom. It would seem as if she could succeed in about anything undertaken, as there isn’t a study which seems to mystify her. She has the wishes of the entire crew for her success.”

Local stores quickly selling out of face masks as coronavirus concerns grow here in the US
FOX 8 Cleveland
Local stores are selling out of face masks amid concerns over the coronavirus, even as the U.S. Centers for Disease Control and Prevention says healthy people should not wear the masks. Shelves are empty at many hardware and drug stores where masks are sold.

Coronavirus checklist: Here’s what experts say you can do to prepare for an outbreak
Dayton Daily News
As Ohio leaders and health officials work to contain the spread of coronavirus, the Ohio Department of Health released a checklist of items and ways to prepare households for any infectious disease outbreak, including coronavirus. The following is a list of things people should keep at their homes and steps they should take to prepare.

Meet the 4 Democrats hoping to win a spot in Ohio’s most competitive state Senate race
Columbus Dispatch
A pharmacist, teacher, lawyer and financial firm manager walked into the Franklin County Board of Elections last year. They all said they were the best Democrat to unseat Hilliard Republican Sen. Stephanie Kunze. But the punch line is that primary voters in the suburban Columbus district can pick only one. Whoever wins the nomination March 17 will find him- or herself in what Republicans and Democrats characterize as 2020′s hardest and most expensive General Assembly race. Well wishes to OPA member Mark Bailey in his race.

Want to avoid the coronavirus?
Findlay Courier
Do you feel scared and helpless as you read the news of the coronavirus? There is a lot of scary news, a lot that still is unknown and a lot that is out of our control. But there are also things individuals — and organizations — can do to prepare. OPA member Steve Martin weighs in.

Charitable Pharmacy, All People’s Fresh Market to open in Linden neighborhood
This Week Community News
Two south Columbus nonprofit organizations are expanding their missions to Columbus’ Linden neighborhood. The Charitable Pharmacy of Central Ohio and Community Development for All People will take over the former Eagle Market, 1464 Cleveland Ave. The Charitable Pharmacy will provide non-narcotic prescription medicine and pharmacy services at no cost for low-income individuals and families, and Community Development for All People offer free fresh produce to needy residents. Congratulations to OPA member Jennifer Seifert!

Powell doctor says she's seen increase in questions, concerns over coronavirus
WBNS 10TV Columbus
OPA member Emlah Tubuo of Powell Pharmacy said there's been an increase in people coming in with questions about the coronavirus, as well as wanting to take extra precautions. When it comes to the masks, she said she is not able to get them because wholesalers are not able to stock face masks. She told 10TV even if she were able to get them, she would argue against everyone wearing them right now.

Reining in out-of-pocket prescription costs
Spectrum 1 News
Rep. Thomas West discusses a few of the stories he has heard from his constituents who have been blindsided by new policies affecting their prescription drug coverage, and what inspired him to help draft the legislation.

Drugs to the doorstep fuels growth at ScriptDrop
Columbus CEO
When he was one of the early employees with Columbus health-care solutions provider CoverMyMeds, OPA member Nicholas Potts began to ponder a problem the pharmaceutical industry calls medication abandonment. “I saw that when a patient drops off a prescription, if they don’t leave the pharmacy with it due to the pharmacy being backed up or insurance issues filling the prescription, about one in four times that patient never returns for that drug,” Potts says.