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MPhA Guidance to Pharmacy Practitioners for Safe Practice During COVID-19 Outbreak

Board of Pharmacy’s Frequently Asked Questions

Please note that this document changes from time to time; we will attempt to update the link as new information is provided.


COVID-19: What's Happening

(5/6/20)

Federal Notification Requirements

On April 30, the US Department of Health and Human Services (HHS) issued new rules governing facilities and imposed new notification requirements amending 42 CFR 483.80(g). Because of the urgency caused by the COVID-19 pandemic, the usual rulemaking process (consisting of notice and a comment period under the Administrative Procedure Act) was waived so the rules can be implemented as soon as possible. These rules are scheduled to take effect on May 8.

Pursuant to the new federal regulations, nursing homes are now required to inform residents, their representatives, and families of those residing in facilities of confirmed or suspected COVID-19 cases in the facility among residents and staff.

Facilities must also:

  1. Inform residents, their representatives, and families by 5:00 p.m. the next calendar day following the occurrence of either a single confirmed infection of COVID-19 or three or more residents or staff with a new onset of respiratory symptoms that occur within 72 hours of each other
  2. Provide cumulative updates to residents, their representatives, and families by at least 5:00 p.m. the next calendar day following each time a confirmed infection of COVID-19 is identified or whenever three or more residents or staff with a new onset of respiratory symptoms occur within 72 hours of each other

Include information on mitigating actions implemented to prevent or reduce the risk of transmission, including whether normal operations in the nursing home will be altered, such as restrictions or limitations to visitation or group activities.

(4/14/20)

The CDC has updated their guidelines for pharmacists.

Here are the changes/additions to this guidance:

  • Everyone entering the pharmacy should wear a face covering, regardless of symptoms. Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
  • Pharmacists and pharmacy technicians should always wear a facemask while they are in the pharmacy for source control.
  • Postpone and reschedule delivery of some routine clinical preventive services, such as adult immunizations, which require face to face encounters.
  • Special considerations for clinics that are co-located in pharmacies.
  • Added more information about cleaning and disinfecting surfaces and included a link to more information about how to clean/disinfect.

(4/8/20)

The Institute for Health Metrics and Evaluation has a real time resource of the current state of the country regarding healthcare needs.

(4/6/20)

PCMA PBM COVID-19 Guidance - Keeping patients and pharmacists safe in this unpredictable time: https://www.pcmanet.org/pharmacy-benefit-managers-stand-with-rx-supply-chain-to-help-patients-access-medications/

Additionally CVS Caremark has released guidance on deliveries and audits. CVS Caremark has suspended new routine pharmacy audits, unless required by law or as a result of certain fraud, waste, and abuse investigations.

Furthermore, CVS Caremark is temporarily allowing pharmacies to document the word “COVID” on its signature log with delivery date and delivery time for retail pharmacy patients that choose not to directly sign. If the pharmacy is delivering the covered item directly to the patient’s home, documenting by writing “COVID Delivery” is permitted when capturing direct signature is not possible.  Signature requirements will be waived in future audits in accordance with the attached guidance.

(4/1/20)

THANK YOU all for what you are doing on the frontlines, serving your industry and communities, helping combat COVID-19!  First Financial Bank is proud to support independent pharmacy and partner with Pace and the state associations to help pharmacists.  We have been helping people through this for the last month, are on daily calls with the SBA, and continue to stay on top of all the options to help you.  For the best solutions to your needs, please reach out to us,  https://www.ffb1.com/loans/pharmacy-loans/pharmacy-solutions.html and on social media @PharmacyLender

If you need to discuss how the CARES Act, Paycheck Protection Program (PPP), or the Economic Injury Disaster Loans (EIDL) relate to your working capital and business needs, please reach out – we are here to help you.  There are emergency funds secured from the SBA, up to $350B in relief for small businesses.  We expect details will be out within 14 days of the recent passing of the stimulus bill, so more to come soon. 

These are uncharted waters and we are all learning as we go, you are not alone.  Like pharmacies, we have weathered financial challenges and natural disasters.  We will all get through this, together!  First Financial Bank has been around for almost 100 years, and has invested nearly $300M in community pharmacy over the last decade.  With a pharmacist and current/former owners on our team for a combined 80 years of pharmacy experience, we know pharmacy and can help you navigate these uncertain times

(3/31/20)

The DEA has released temporary guidance on emergency prescriptions for CII prescriptions. The following two points:
1) an emergency prescription can be authorized by a pharmacists as long as it is followed up with a written prescription within 7 days
2) Faxed or photographed prescriptions are accepted during this pandemic

(3/24/20)

Minnesota Department of Health Funding Available

MPhA hopes that you are all staying safe and healthy during this unprecedented time. The Minnesota Department of Health has made some funding available to health care providers during COVID-19. If you are interested in looking into funding to assist your business, please go to the following website for additional information: https://www.health.state.mn.us/facilities/ruralhealth/funding/grants/covidgrant.html

The application can be found on the website. 

Please note that all applications were due by Midnight on March 25.

Additional funding is expected to come in future weeks. However this should assist pharmacists during February and March.

If you have any questions about the funding or the application, please reach out to Sarah Derr at sarahd@mpha.org or via cell phone 763.227.9622.

(3/18/20)

In light of the rapidly evolving COVID-19 pandemic, the demand for garbing and personal protective equipment (PPE) and alcohol-based hand sanitizer is expected to outpace available supply. During this pandemic, USP supports State Boards and other regulators using risk-based enforcement discretion related to the implementation of USP compounding standards and the compounding of alcohol-based hand sanitizers for consumer use.

The USP Compounding Expert Committee developed the following informational resources that may be of assistance during this public health emergency: 

  1. USP Response to Shortages of Garb and Personal Protective Equipment (PPE) for Sterile Compounding During COVID-19 Pandemic
  2. Compounding Alcohol-Based Hand Sanitizer During COVID-19 Pandemic

Any additional questions should be directed to the USP Healthcare Quality and Safety staff at CompoundingSL@usp.org.

Care for Children of Families of Emergency Workers
Under the Gov. Walz’s Executive Order 20-02, free school-age care for the children of emergency workers (including providers of health care, emergency medical services, long-term and post-acute care; law enforcement personnel; personnel providing correctional services; public health employees; firefighters and other first responders; and court personnel) was outlined. The orders directed schools to provide care to, at a minimum, district-enrolled students aged 12 and under.

In order to ensure that we are providing for the needs of our students, we are clarifying the work that falls within each of the identified emergency workers categories.

Additionally, this guidance can be used by child care providers who are willing to prioritize the needs of these workers during this unprecedented emergency.

Emergency Workers in Tier I under the Executive Order
Healthcare personnel...
Pharmacy employees necessary for filling prescriptions..."
(Pharmacy personnel is not included in DOE Teir 2 essential workers.)

(3/17/20)

  • Due to a national shortage of COVID-19 testing materials the Minnesota Department of Health has issued guidance to prioritize testing for patients in high priority groups such as those hospitalized, health care workers, and those in congregate living situations such as long-term care facilities. More details can be found here.
  • The Minnesota Legislature approved emergency funding legislation today in order to respond to the COVID-19 crisis. This bipartisan proposal will take $200 million from the general fund and place $50 million into the state health care contingency fund and provide $150 million in grants to hospitals, emergency responders, long-term care providers and pharmacies responding to the crisis. The Minnesota Legislature will be leaving session and working on an “on-call” basis from now until April 14. See the Star Tribune article here.
  • On Monday March 16, the Minnesota Board of Pharmacy published a Frequently Asked Questions (FAQ) document on the Board’s webpage about COVID-19. This document provides crucial answers to common questions regarding pharmacy practice during this crisis. The document can be found here. The Board is also requesting all pharmacists with crucial questions to submit their questions to this email: pharmacy.board@state.mn.us. The FAQ will be updated as more questions are received and updated documents will be posted at the link above.
  • Governor Tim Walz issued executive order 20-04 on Monday. March 16, which effectively closes all bars, restaurants, and places of public accommodation effective Tuesday March 17 at 5 pm until March 27 at 5 pm. This order has now been extended to May 1 for bars and restaurants. Places that serve food and drink may still continue to offer delivery and take-out services. This executive order does not include: places that provide food for off-site consumption such as grocery stores, crisis shelters, or health care facilities. See the full executive order here.
  • As of March 25 there are 287 confirmed cases of COVID-19 in Minnesota out of the 11,500 that have been tested. Ongoing counts can be found here.

The Minnesota Department of Health (MDH) is closely monitoring the developing situation in Minnesota in regards to the SARS-CoV-2 virus pandemic. The current status of coronavirus disease (COVID-19) is posted below. Figures will be updated on the MDH website - here.

Pharmacists and pharmacies play an integral part in the health of Minnesotans. Therefore, it is essential that we maintain the health of pharmacy staff so that pharmacies can maintain their operations. Also, the communication of accurate information is imperative in our communities. When patients ask pharmacists and pharmacy staff for guidance, please use calm and reassuring language.

Pharmacies should implement strategies to prevent person-to-person transmission of infection: Frequent, effective handwashing, use of hand sanitizer and wiping frequently touched surfaces. See the EPA website for approved biocidal materials here and in the resources section below. Individuals should maintain a distance greater than 3 feet from patients, and greater than 6 feet for patients actively coughing. Communicate to patients the importance of staying home if having symptoms, sending a friend to the pharmacy instead, or using the drive through at pharmacies if possible. 

Individuals who develop symptoms should not go to work, should call in sick and self-quarantine at home until they no longer have a fever and their symptoms improve. Pharmacies should begin to develop emergency plans based on the potential for absenteeism of staff due to illness. The situation is continually developing and may eventually be worsened by drug shortages. The MPhA will continue to share information between state and local public health staff and our pharmacy community.


Resources

COVID Act Now

MDH Resources

U.S. Centers for Disease Control and Prevention (CDC)’s webpage on the novel coronavirus

CDC Healthcare Personnel with Potential Exposure to COVID-19

CDC Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of 

COVID-19 in the United States

EPA Registered Antimicrobial Products for Use Against Novel Coronavirus SARS-CoV-2

ASHP COVID-19 Resource Center

World Health Organization (WHO)’s Situation Reports

Policy for Temporary Compounding of Certain Alcohol-Based Hand Sanitizer Products During the Public Health Emergency

From CPESN USA and NCPA, best practices for community pharmacies depending on four patient scenarios

APhA is offering home study for pharmacists and technicians, free to members and nonmembers

The Drug Enforcement Administration (DEA) Guidance regarding the issuance of oral schedule II prescriptions

Economic Disaster Loan Program (EIDL)      

  • Administered by the SBA
  • Maximum loan amount is $2 million
  • The term of the loan can be up to 30 years and the rate will be 3.75%
  • No payments during the first year

CARES Act and Paycheck Protection Program**     

  •  Accessed through banks in partnership with SBA
  • The loan amount is the lesser of $10 million or 2.5 times your monthly payroll      
  • The term of the loan is 10 years and the interest rate will be 4%
  • Payments are deferred for at least 6 months and up to 12 months
  • Loan forgiveness option is offered based on eligible uses of loan proceeds  

SBA Resources   

**The Paycheck Protection Program guidelines from the Small Business Administration have not yet been finalized or issued to participating lenders such as First Financial Bank.  Guidelines pertaining to eligibility, the use of loan proceeds, and loan forgiveness are forthcoming. 
Again FFB is closely monitoring these loan programs and encourages you to do so as well.  Please contact us should you have any questions or interest in the above programs. First Financial Bank - Pharmacy Lenders

Families First Coronavirus Response

APhA’s Pharmacists’ Guide to Coronavirus contains information, resource, training materials, links to public resources, and more. Additionally, find all of APhA’s policy and advocacy information, including COVID-19 statements and comment letters at this center. 

Safe Medicines COVID-19 Resources

COVID-19: Evidence-Based Medicine - University of Minnesota

APhA COVID-19: Demystifying Testing

NCPA/CPESN Resource

How To Get a CLIA Waiver

Healthcare Ready


Contact

MDH has set up a COVID-19 public hotline that is open 7 a.m. to 7 p.m. The hotline number is 651-201-3920.

Please send additional COVID-19 Specific questions to Executive Director Sarah Derr at covid19@mpha.org

MPhA is collecting as many questions as possible to determine how best to serve the Minnesota Pharmacy Community.”

    Minnesota Pharmacists Association

     

    1000 Westgate Drive, Suite 252, St. Paul, MN 55114 | Phone: 651.697.1771 Fax: 650.290.2266 Email: info@mpha.org

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