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Friday, March 27, 2020
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COVID-19 Recommendations for Texas Pharmacists

Texas pharmacists and their staff are busy working on the front lines to care for patients amid the coronavirus/COVID-19 pandemic. The health and safety of pharmacy professionals is paramount during this declared state of disaster. The Texas Pharmacy Association has compiled recommendations from the CDC, other states, national associations, and other sources to help pharmacists and their staff members practice in a safe and effective manner.

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COVID-19 Recommendations for Texas Pharmacists
TPA Members Support Federal Pharmacy Legislation

Texas Pharmacy Association members were among the thousands who responded to a call this past week from our national association partners to tell Congress to address pharmacy issues in COVID-19 legislation.

U.S. Capitol

Rep. Buddy Carter (R-Ga.), the only pharmacist in Congress, along with 35 House colleagues sent a bipartisan letter to House and Senate leadership with language outlining efforts to provide authority for pharmacist provider status under Medicare Part B to allow pharmacists prescriptive authority and health testing capabilities to address the COVID-19 virus as well as flu, strep, and other minor ailments for the duration of this public health emergency. Unfortunately, this legislation was not part of the Senate package that passed this week and won’t be part of the final bill.

Meanwhile, more than 50 lawmakers sent a bipartisan letter to Congressional leadership supporting community pharmacy's plea for DIR relief. The letter noted that “many pharmacies are finding it increasingly difficult to stay in business due to unpredictable direct and indirect remuneration (DIR) fees imposed by pharmacy benefit managers (PBMs)." It asked leaders to “consider pausing DIR fees on pharmacies for the remainder of 2020, and ensuring the fees prohibited during this time are not assessed on pharmacies after the coronavirus pandemic has ended.” This provision will not be part of the final stimulus package that is to pass this week; however, this issue isn’t off the table because there are likely to be additional federal legislative packages.

TPA Requests Increased Reimbursement for Delivery Services

This week the Texas Pharmacy Association wrote to ask Texas Medicaid Director Stephanie Muth to include in Texas’ federal waiver request of the Centers for Medicare & Medicaid Services (CMS) an increase in pharmacy reimbursement for prescription delivery services to Medicaid beneficiaries during the COVID-19 outbreak.

Texas Health and Human Services
These home delivery services are essential to help Medicaid beneficiaries practice social distancing while ensuring they maintain access to their life-saving medications. CMS has taken steps to remove red tape to allow states more flexibility in amending their Medicaid programs to provide appropriate benefits to respond to the COVID-19 outbreak, including an adjustment to the professional dispensing fee to account for additional costs incurred by pharmacists for home delivery. TPA urged Texas Medicaid to act and include pharmacy’s needs in its federal request.
Last Call: Presentation Proposals Due TODAY
2020 Call for Education Programs and Presentations

The Texas Pharmacy Association is looking for insightful presentations by dynamic speakers to challenge our thinking and push the profession forward. Your expertise can help your colleagues stay on top of the latest advancements in pharmacy and patient care. Our 2019 Pharmacy Needs Assessment identified knowledge gaps that we are committed to address with high-quality education programs. Proposals are due today, March 27. TPA’s Rxperts Center for Excellence and the TPA Conference & Expo each provide pharmacy professionals up-to date education on pharmacy law and regulations, disease state management, patient safety, the latest technology, and skills needed in personal and professional settings.

Submit Your Proposal Today
Recognize a Deserving Member: 2020 TPA Award Nominations Due April 15
2020 Award Nominations

The TPA Association Affairs Council is seeking nominations for several prestigious Association awards to be presented during the 2020 TPA Conference & Expo (July 24–26 in Austin). All nominees must be in good standing with the Texas Pharmacy Association and have made contributions to the profession that align with TPA's mission to enhance and evolve the role of pharmacy in delivering health care solutions and improving patient outcomes.

Review the list of awards requirements and submit the online nomination form no later than April 15, 2020. View a list of 2019 award winners and past honorees online.

Nominate a Deserving Member Today


Abbott Waives Regulations, Allows Telephonic Pharmacy Consultations

Governor Greg Abbott last Friday announced that he is temporarily suspending certain regulations to ensure that Texans will have continued access to their pharmacists as the state responds to COVID-19. The Governor’s actions allow pharmacists to conduct telephonic consultations, and remove regulatory barriers so that pharmacies can operate at full strength.

Office of the Texas Governor (March 20, 2020)

TSBP Issues Adopts New Rule Concerning Medication Limitations, Temporarily Suspends Certain Rules

The Texas State Board of Pharmacy held an emergency meeting Friday, March 20, to address issues related to the declared state of emergency surrounding the coronavirus pandemic. The Board temporarily suspended certain rule requirements and adopted a new rule on an emergency basis concerning medication dispensing limitations for drugs with potential to treat COVID-19, including chloroquine, hydroxychloroquine, mefloquine, and azithromycin.

Texas State Board of Pharmacy (March 20, 2020)

Don’t Rely on Postcard; Check Date for State License Renewal

The Texas State Board of Pharmacy says that due to COVID-19-related problems with the vendor who normally sends its renewal reminders, the Board may not be able to individually notify licensees or registrants regarding their pending expiration date with a postcard. The Board is working to notify all impacted individuals and entities via email, but license holders should check their renewal date to ensure that their license/registration remains active.

Texas State Board of Pharmacy (March 24, 2020)

Medicaid PDL Changes to the Bronchodilators, Beta Agonist Drug Class

On March 21, the Medicaid Vendor Drug Program changed the preferred drug list status of certain Albuterol products from non-preferred to preferred. This is a temporary change to address reported drug shortages for short-acting agents in the bronchodilators, beta agonist drug class. This allows providers to prescribe these drugs without requiring a non-preferred prior authorization and allows Medicaid patients continued access to necessary medication.

Texas Health and Human Services Commission (March 21, 2020) Vendor Drug Program

Attorney General to Hold Supply Chains Liable for Price Gouging

Texas Attorney General Ken Paxton issued a stern warning to retail suppliers, including those who supply grocery stores and pharmacies, that state law strictly prohibits price gouging in the wake of a declared disaster. Any price-gougers may be required to reimburse consumers and may be held liable for civil penalties of up to $10,000 per violation with an additional penalty of up to $250,000 if the affected consumers are elderly.

Texas Attorney General (March 21, 2020) Paxton, Ken

High: Emergency Drug Limits Benefit Patients with Lupus

TPA Member Carter High, President of TPA-affiliate Alliance of Independent Pharmacists of Texas, spoke to a Dallas-area TV station about the Texas State Board of Pharmacy's recent emergency order limiting orders of drugs that may help treat COVID-19. High said he hopes the new order will prevent people from "hoarding" and "stockpiling" the drug. “If those drugs are completely gone for someone to get, that could put someone with lupus in a very bad scenario and mean hospitalization for them potentially,” he said.

KTVT-TV (March 26, 2020) New, Brian

Pharmacies Step Up COVID-19 Safety Measures While Staying Open

Curbside is how customers are now picking up prescriptions and other items at Tarrytown Pharmacy near downtown Austin. “In the 79 years that we’ve been open, we’ve never had to close our doors before and we never want to, but really our intent is to keep the community safe and prevent the spread of the virus,” says TPA Member James Cong. The Texas State Board of Pharmacy says there are no specific rules right now about drive-thru or delivery.

KXAN-TV (March 23, 2020) Doost, Arezow


APhA, ASHP, AMA Address Inappropriate Ordering, Prescribing or Dispensing

The American Pharmacists Association, American Society of Health-System Pharmacists, and American Medical Association issued a joint statement strongly opposing actions by physicians and others who are prophylactically prescribing medications identified as potential COVID-19 treatments for themselves, their families, or their colleagues; as well as some pharmacies and hospitals that have purchased excessive amounts of these medications.

American Pharmacists Association (March 25, 2020)

USP Updates Hand Sanitizer Compounding Resources for COVID-19

USP has updated its guidance titled Compounding Alcohol-Based Hand Sanitizer During COVID-19 Pandemic in response to stakeholder questions about substitutions in light of shortages of ingredients. In addition, Formulation 3 was revised due to inherent variability in the raw materials and volatility to ensure that the isopropyl alcohol concentration exceeds CDC recommendations.

United States Pharmacopeia (March 25, 2020)

Pharmacy Responds to PCMA in Supreme Court PBM Case

Pharmacy groups responded to the Pharmaceutical Care Management Association's (PCMA) brief of respondent which opposes states' rights to regulate pharmacy benefit managers in Rutledge v. PCMA. "The PBMs have been hiding behind the false argument that ERISA preempts the states from adopting reasonable regulations," said NCPA CEO Douglas Hoey.

National Community Pharmacists Association (March 25, 2020)

CMS Waives Signature Requirement for Part D During Pandemic

CMS issued a letter to Medicare Part D plan sponsors explaining that "requiring a patient signature for receipt of medication could undermine current public health efforts to combat the spread of the coronavirus" and that "HHS does not require and will not audit for patient signatures as proof of delivery for any medications, including for controlled substances."

Centers for Medicare and Medicaid Services (March 20, 2020)

SBA Provides Disaster Loans, Other Resources

The Small Business Administration (SBA) is offering low-interest federal disaster loans of up to $2 million to manage revenue loss and expenses in states that have declared a state of emergency. SBA is also providing updated information about delayed tax filing and payment deadlines from the IRS, among other resources.

U.S. Small Business Administration (March 25, 2020) Office of Advocacy

CPESN Launches COVID-19 Best Practices Site

The Community Pharmacy Enhanced Services Network (CPESN USA) has launched a web site to share best practices at community pharmacies during the COVID-19 pandemic. The site also includes a standard of plan care document for interacting with patients.

CPESN USA (March 2020)

FDA Issues Guidance on Patient Access to Certain REMS Drugs

The FDA issued a new guidance to sponsors and healthcare providers regarding certain Risk Evaluation and Mitigation Strategy (REMS)-required testing during this time. FDA recognizes that patients may be self-isolating and/or subject to quarantine, and undergoing testing or imaging to obtain a drug subject to a REMS can put patients and others at risk.

U.S. Food and Drug Administration (March 22, 2020) Kahn, Jeremy

FDA to Regulate Insulin as Biological Product

The FDA this week changed how it regulates insulin and other biologics, such as human growth hormone and chorionic gonadotropin, to treat them as biological products rather than drugs. The move means any insulin approved as a so-called "follow-on" is now considered a biosimilar and interchangeable with branded products, which could reduce costs.

U.S. Food and Drug Administration (March 23, 2020) McKinney, Jim

FDA Issues Alert about EpiPen Auto-Injector Errors

FDA is alerting patients, caregivers and health care professionals that EpiPen 0.3mg and EpiPen Jr 0.15mg auto-injectors, and authorized generic versions, may potentially have delayed injection or be prevented from properly injecting. It is important for providers, patients and caregivers to periodically review the EpiPen user instructions and practice using it.

U.S. Food and Drug Administration (March 24, 2020) McKinney, Jim

Congress Unlikely to Move Drug Price Bills Soon

Some lawmakers working on legislation to reduce drug prices and rein in surprise billing had hoped to attach language to bills renewing health care programs set to expire in May, but the coronavirus response package will renew those programs until Nov. 30.

The Hill (Mach 24, 2020) Sullivan, Peter

NABP, PTCB Provide Testing Updates

The National Association of Boards of Pharmacy (NABP) has issued an update regarding NAPLEX and MPJE candidates, including testing center closures, waiving of rescheduling fees, possible eligibility extensions, and Authorization to Test (ATT) information. Likewise, the Pharmacy Technician Certification Board (PTCB) is publishing updates concerning testing; recertification deadlines have been extended 60 days.

National Association of Boards of Pharmacy

Pharmacy Technician Certification Board


Independent Pharmacies Fight Back

Many independent drug store operators are finding a path to success by expanding into new, more profitable areas and exiting from unprofitable ones, as well as strengthening community ties and maintaining tight control of expenses. There's continued interest from young pharmacists seeking to become independent owners and embracing new models of care.

Drug Store News (March 24, 2020) Hamstra, Mark

Pharmacists’ Stories of Serving During  Pandemic Will Never Be Forgotten

Pharmacists and pharmacy personnel are already on the front lines. In many cases, they’re using improvised solutions to protect themselves and their patients from coronavirus transmission. Pharmacists and pharmacy technicians have stepped up. The stories of their heroic service will be told forever. They deserve protection, appreciation, and recognition.

American Pharmacists Association (March 24, 2020) Menighan, Tom

When Might Experimental Drugs to Treat Covid-19 Be Ready? A Forecast

There is a desperate need for new medicines to treat Covid-19, the disease caused by the novel coronavirus that has shut down much of the world. A vaccine to prevent infection entirely would be even better. Drug companies and medical researchers are making heroic efforts to deliver new medicines.

Stat (March 24, 2020) Herper, Matthew

COVID-19: What Community Pharmacies Are Doing in the Hardest-Hit States

Community pharmacists remain on the frontlines of public health by serving as direct points of access for their patients. Ken Thai, president of the California Pharmacists Association, noted that, as grocery and convenience stores are forced to limit access, many neighborhood independent pharmacies are the last community resource for basic hygiene and health needs.

Drug Topics (March 19, 2020) Ientile, Gabrielle

Mask Shortage Straps Pharmacists Who Need Them to Keep Medicines Pure

Pharmacy staff who prepare IV drugs inside hospitals are the latest health care workers decrying a shortage of masks as they scramble to prepare medications for patients with everything from cancer to COVID-19. The staffers wear surgical masks while preparing liquid medications injected into patients’ veins to ensure the medication remains sterile.

Kaiser Health News (March 20, 2020) Jewett, Christina and Lupkin, Sydney

COVID-19 Response Highlights Pharmacists' Value

Globally and in the U.S., pharmacists are being called on to provide not just medications, but importantly to be a source of critical information and support for the public. First and foremost, we have a duty to serve our patients, but we also have an unprecedented opportunity to take our profession to another level and demonstrate the unique value of the pharmacist.

Pharmacy Times (March 19, 2020) Steiber, Dan

The Future of Health System Pharmacy Looks Bright

The American Society of Health-System Pharmacists recently published its Practice Advancement Initiative 2030, which looks forward to coming changes to pharmacy practice within both acute and ambulatory settings. As the past decade has illustrated, allowing pharmacy practice to evolve is of paramount importance to our patients and the profession.

Pharmacy Today (March 2020) Sweeney, Joey

PBM Policies Prevent Misuse of Potential COVID-19 Drugs

CVS Health and Express Scripts are setting policies for access to hydroxychloroquine, azithromycin, albuterol inhalers and a protease inhibitor to prevent hoarding of drugs that might be crucial in treating patients with COVID-19. An Express Scripts spokeswoman said the pharmacy benefit manager is also working with manufacturers to meet surging demand.

Reuters (March 25, 2020) Humer, Caroline and Mishra, Manas

Small Study Finds Hydroxychloroquine Innefective for COVID-19

Data from a 30-patient clinical trial conducted at the Shanghai Public Health Clinical Center in China found no significant clinical benefit associated with the use of hydroxychloroquine to treat COVID-19. Researchers said a larger trial is needed to confirm the results, and the team said different dosages could still prove effective.

Forbes (March 25, 2020) Haseltine, William

BP-related Death Rates Increase in Rural, Urban Areas

Data on more than 10 million US deaths from 2007 to 2017 showed mortality rates linked to high blood pressure increased 72% in rural areas and 20% in urban areas, with the South experiencing the biggest increase. Poor diet coupled with high obesity and diabetes rates, along with a lack of access to health care, could be a factor in regional differences.

Health Day News (March 23, 2020) Preidt, Robert

How to Protect Your Mental Health During the Coronavirus Pandemic

As we are being asked to self-quarantine, it has become increasingly significant to pay as much attention to our mental health as we do to our physical health. If you've been feeling anxious, frustrated, angry or downright confused lately, know that you're not alone—we are all in this together. So take a deep breath and follow these handy, expert-backed strategies.

Forbes (March 24, 2020) Nazish, Noma

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Texas Pharmacy Today
Editor: Brian Sparks, Division Director, Communications and Marketing
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Texas Pharmacy Association
Debbie Garza, R.Ph., Chief Executive Officer
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Texas Pharmacy Today is a weekly e-newsletter for members of the Texas Pharmacy Association, 3200 Steck Avenue, Suite 370, Austin, TX 78757. According to Texas Government Code 305.027, portions of this material may be considered "legislative advertising." Authorization for its publication is made by Debbie Garza, CEO, Texas Pharmacy Association.

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