Rx Response Specificity: All-hazards Program Description The single point of contact for the private sector pharmaceutical supply system requests for information, pharmaceutical supply status & pharmacy status. The members of the Rx Response coalition include: American Hospital Association (AHA) American Red Cross Biotechnology Industry Organization (BIO) Generic Pharmaceutical Association (GPHA) Healthcare Distribution Management Association (HDMA) National Association of Chain Drug Stores (NACDS) National Community Pharmacists Association (NCPA) Pharmaceutical Research and Manufacturers of America (PhRMA) Resources available 1. Pharmaceutical supply system status report available on www.rxresponse.org website during emergency activations. Information included includes event impacts on critical medication supply from: Manufacturing (e.g., facility that produces a critical medicine has been flooded and will not be operational) Distribution (e.g., road closures or credentialing barriers that prevent delivery of pharmaceuticals) Dispensing (e.g., community pharmacies that have re-opened in the impacted area) 2. Communications network to the pharmaceutical system which can broadcast product, resource, information or information requests on behalf of State Emergency Management and Public Health. Examples of communications may include: Manufacturing o Requests for pharmaceutical product Distribution o Requests for pharmaceutical product o Requests for assistance in distribution capability (trucks, storage facilities, etc) Page 1
Dispensing o Requests for pharmaceutical product unable to be acquired by BSPS central pharmacy, MCAP, or other contracted venders o Requests for mobile pharmacy placement in an Area of Operations Information to pharmacies regarding patient assistance programs, executive orders that affect pharmacy refills, or public health emergency orders. Contact information Web Site Email Addresses www.rxresponse.org alerts@rxresponse.org: Email address for disaster-related information, product requests, or requests for information. reports@rxresponse.org: Email address for recurring reports such as situation reports. contactus@rxresponse.org: General outreach to Rx Response program, and non-disaster related communications. admin@rxresponse.org: Users who need assistance with website access or functionality should send an email to this address. Operations Center Phone (866) 247-2694 (202) 715-7200 Operations Center Fax (202) 715-7199 Primary Operations Center 950 F Street, NW (Suite 300) Location Washington D.C. 20005 Activation Process The program self-determines activation. Because existing relief plans and emergency medical services programs are sufficient to address local or smaller regional public health emergencies, the Rx Response program will focus on addressing major domestic public health emergencies of national significance rather than those emergencies that affect a limited population or geographic area. While public health emergencies will be determined on a case-by-case basis, there are a number of existing mechanisms that will be used by Rx Response to help guide decision-making: Disaster declaration by a U.S. Governor or the U.S. President Page 2
American Red Cross Level V+ Event Department of Homeland Security (DHS) Severe Classification World Health Organization (WHO) Phase IV+ Event (Pandemic Influenza) Health and Human Services (HHS) Stage 2+ Event (Pandemic Influenza) Other situations warranting a response as determined by the respective decision-making bodies within the represented pharmaceutical industry groups Event Description Localized Events (e.g., tornado, localized bombing, flu outbreak) Regional Natural Disasters (e.g., earthquakes, fires, floods and hurricanes) Large-Scale Acts of Terrorism Pandemic Events Timelines Effect on Pharmaceutical Product Minimal; normal supply system expected to address limited barriers (if any) Potentially significant; pharmaceutical product may not be able to reach disaster area or cannot be prescribed or dispensed. Potentially significant; pharmaceutical product may not be able to reach disaster area or cannot be prescribed or dispensed. Collective forum to work with government agencies to address barriers to critical product delivery; voice to HHS response leadership and DHS Critical Infrastructure Program Rx Response Strategy Monitor and report eventspecific information, as appropriate Activate the program Monitor the situation Share information with partners Identify and resolve barriers; where possible and appropriate Activate the program Monitor the situation Share information with partners Identify and resolve barriers; where possible and appropriate Activate the program Monitor the situation Share information with partners Identify and resolve barriers; where possible and appropriate Monitoring will begin 96-72 hours pre-impact for with-notice events. No-notice events will require approximately 24-48 hours for facilities assessments to be conducted and reported. Communications to member organizations & companies can be completed in 1-2 hours from time of request. Page 3
Product or resource delivery timelines are dependent on the specific companies that are responding to the request. Limitations 1. Member companies act as first-line responders. Rx Response cannot act as a broker/vendor or direct operations of member companies. Page 4
In Case of Emergency Prescription History (ICERx.org) Specificity: All-hazards, large-scale evacuations Program Description During a public health emergency, a significant roadblock to getting medicines to patients in need occurs even when the pharmaceutical supply system delivers medicines to the traditional dispensing locations. Though medicines are available, pharmacists are unable to dispense pharmaceutical product due to the inability to confirm the validity of prescriptions and access the patient s medical history. Hurricane Katrina highlighted this issue when evacuated persons were unable to obtain life-sustaining drugs they needed because their medical history was unavailable. In addition, many patients did not know the names or doses of the medications they were taking, further complicating the problem. ICERx.org is a joint-initiative between the American Medical Association (AMA), Informed Decisions, the National Association of Chain Drug Stores (NACDS), the National Community Pharmacists Association (NCPA), RxHub and SureScripts, as well as state Medicaid and other government agencies that hopes to address this issue. Resources available The ICERx website enables authorized physicians and pharmacists assisting with a disaster relief effort to access the In Case of Emergency Prescription (ICERx) database containing medical records provided by the nation s pharmacies, pharmacy benefit managers and state Medicaid programs. Once an emergency occurs, licensed healthcare professionals registered on ICERx.org will be able to access: Evacuee prescription history information, including drug name, dosage, quantity, day supply, the name of the provider who wrote the prescription and the pharmacy that filled it Available patient clinical alerts, including drug interaction, therapeutic duplication and elderly alerts Clinical pharmacology drug reference information, including drug monographs, interaction reports and drug identifier tool Contact information Website: www.icerx.org Phone: (888) 423-7950 Borden Wilson (813) 579-2754 bwilson@id-health.com Kathy Mosbaugh kmosbaugh@id-health.com Page 5
Activation Process Threshold for activation is a presidential declaration. The program self-determines activation after the declaration has been announced. Timelines The program can be activated within 12-24 hours of a presidential declaration being approved, and generally remains active for 30 days from the declaration. Notifications Immediately after a presidential declaration has been declared, ESF8 should notify the ICERx program (email to Borden Wilson and Kathy Mosbaugh). When ICERx notifies ESF8 that the program has been activated, that information should be shared widely within the pharmacy community, for example: Florida Board of Pharmacy All public health departments Florida Pharmacy Association Florida Society of Health-System Pharmacists Rx Response Colleges of Pharmacy Limitations 1. The program is dependent on partners for information. While the pharmaceutical benefits managers and partnering pharmacies cover the vast majority of prescription history information, some gaps remain, such as many state Medicaid programs. 2. Because of varying state confidentiality requirements, ICERx.org does not contain information on medications for HIV/AIDS, mental health issues, and substance abuse or chemical dependencies. 3. The ICERx program does not provide information on patient insurance coverage. ICERx.org Frequently Asked Questions: http://www.icerx.org/faq.pdf Page 6
Emergency Prescription Assistance Program (EPAP) Specificity: All-hazards Program Description The Emergency Prescription Assistance Program (EPAP), a joint program of the Federal Emergency Management Agency and the Department of Health and Human Services, provides an efficient way for pharmacies to process claims for prescription medications and limited durable medical equipment (DME) provided to individuals who are from a disaster area declared by the President and who do not have any form of health insurance coverage. Claims for individuals with private insurance, such as an individual health insurance policy or employer-sponsored coverage, public insurance, such as Medicare, Medicaid, or other third party coverage, are not eligible for payment under the EPAP. Prescriptions are filled at community pharmacies, with EPAP serving as a payor of last resort. Resources available Funding to cover prescription medications for persons impacted by disasters Contact information EPAP hotline: (866) 935-4135 Chris Worrall chris.worrall@cms.hhs.gov Activation Process Requires a Mission Assignment to HHS, after a major disaster declaration has been approved by the president Timelines Program can be activated within hours after approval of the mission request. Notifications When EPAP notifies ESF8 that the program has been activated, that information should be shared widely within the pharmacy community, for example: Florida Board of Pharmacy All public health departments Page 7
Florida Pharmacy Association Florida Society of Health-System Pharmacists Rx Response Colleges of Pharmacy Limitations 1. Program only covers those without other insurance coverage, and does not cover cost-sharing such as co-pays. Page 8