With supply chain turmoil and some empty shelves these days, plan ahead before that last pill, drop of over-the-counter medication or cup of pet food.
Regional health experts say there is no need for stockpiling. It’s more about evaluating what’s in the house, like the last dog food (see pet sidebar).
Pharmacies have also been hit hard across the country with staff shortages. Problems that started before the pandemic have worsened, causing shortened business hours and temporary or permanent closures, said Julie Akers, a pharmacy law expert at Washington State University.
Prescriptions have refill limits, she said, “but you don’t want to wait until that last day.” “In addition to having access to pharmacy issues, we often see patients who are out of refill and don’t realize they need a new prescription.
“Whether it’s for epidemiological reasons or concerns about temporary closures and access, or just in general, it’s a good idea to have a minimum supply of three to four days.”
After the recent temporary closure of a CVS pharmacy inside Target on South Regal Street, Spokane resident Don Cutler attempted to call a number listed on a sign. That didn’t lead anywhere, Cutler said, so he later called his doctor to move his prescriptions to another pharmacy.
“We first learned of its closing on October 27,” Cutler said. “I called a CVS number and held it for about an hour, then got someone who had no idea what was going on.”
He said he was not promised a call back. “We can deal with this; we know our doctor, so we can sail. We know someone who has had serious prescriptions for blood-thinning medication, and who has had a real problem.”
One target employee told The Spokesman-Review that the pharmacy’s temporary closure in late October was due to staffing problems. Letters requesting information from CVS were not returned, but the pharmacy website reopened on November 8.
Overall, Akers said there are two issues affecting the industry: a pre-pandemic shortage of pharmacy technicians that worsened and pharmacies affected by fees and lower insurance payments.
“We have the extra burden now in pharmacies where they do a lot of COVID testing as well as immunizations now,” Akers said. It’s flu season. Most people in our state get a flu shot from a pharmacist or trained pharmacy technician. With staffing issues, we went into the pandemic with pharmacies under severe strain due to a lack of technicians already, and this has only swelled.
“A lot of the issues we see in community pharmacies have historically revolved around paying for prescriptions through pharmacy benefit managers or PBMs that are kind of an intermediary between the pharmacy and the actual insurance company.”
Akers added that the pharmacy submits a claim for each patient’s prescription to the PBM, which responds to the payment the pharmacy will receive for that prescription.
“Many pharmacies are at a point where they have little revenue which often leads to a loss in drug cost,” she said. This is accompanied by the so-called direct and indirect bonus fees.
“They are called DIR fees which are implemented by PBMs where after months of filling a prescription, they will review the data collected from the pharmacy regarding any of the prescriptions they have filled, and they will do what is called a refund fee.”
These fees start for quality metrics, and if they are met, they mean a lower refund fee or maybe nothing. Akers said transparency about the procedures is a concern. Five-year trends show that more independent pharmacies are affected by lost revenue, which are closed or sold to larger establishments.
“Some of these DIR fees are in the millions of dollars,” she said. “Even the big companies are hurt by this.”
Akers said these issues affect hiring because salaries come from sales and revenue. In the past five years, another trend is to reduce hiring hours. Then, employees get sick, and they must quarantine or take care of the family, along with COVID-19 tests and vaccinations.
“Where you had two pharmacists working in a pharmacy in one day relative to their size, you might have one and a half pharmacists that day or just one pharmacist working a 12-hour shift.
“Same with technicians, where you might have three technicians to help with the volume, you see the stores go down to two or one. It’s really overwhelming to have the pressure to get all that volume of work done and ensure patient safety.”
Nationally, drug shortages occurred long before the pandemic, said Daniel Baker, professor of pharmacotherapy at Washington State University. Components or supplies may be overseas. “Obviously the situation has gotten worse under COVID-19, and for many different reasons, but it is not a new problem,” he said.
Factors include fewer manufacturers making widely used drugs, contaminants taking the drug off the shelves, and unpredictable growing demands. If people experience shortages, Baker said it’s best to work with a pharmacist to locate a supply or offer an alternative.
“Sometimes it is easy to switch to another similar drug. Another problem we are having is not having a single computer network to locate products.”
There are also some supply chain issues. “The worst problem we have right now is that it is a shipping issue from the manufacturer. It could be sitting on a truck or a train somewhere in the US.”
However, about most products, Baker said, “It shouldn’t be a problem for the majority of people.”
Akers said Washington state has requirements for permanent closures to notify the Pharmacy Commission at least 30 days in advance and locate records and products. Patients must have a 30-day advance notice with pharmacy signage and either direct mail or newspaper general notice. Little is required for temporary closure.
“If they’re temporarily changing the hours, there aren’t really any laws or rules,” Akers said. “Pharmacies are expected to have signage indicating opening hours, but they are flexible if there are emergencies and should be closed temporarily.”
Patients can try calling another pharmacy in the same chain, asking for a delivery or requesting a prescription conversion, she said. Your health care provider may cover this gap. “Often your provider will give you a one-week supply or a one-month supply depending on the medication.”
Baker said some newly developed drugs are slowing to reach the market under pandemic travel restrictions for federal workers approving approvals. They could not go to the factories, now there is a backlog.
“We have a number of recent medications that have missed their potential approval date.”