In preparation for Hurricane Irma, several southeastern states have declared states of emergency. This planning includes provisions for maintaining access to necessary medical care during the time of the declared emergency.
The actual path of Irma into the southeast is yet to be determined so it is likely that the declarations of emergency will evolve as the storm makes landfall on the continental United States. The Mitchell team is monitoring the situation as it unfolds and will provide you with relevant information during this unpredictable time to help you respond to the individuals you serve.
Below are summaries of the Executive Orders issued and the relevant impact on pharmacy services.
Governor Rick Scott issued an Executive Order declaring a state of emergency in all counties in Florida. The order delegates power to state agencies to “suspend the effect of any statute, rule, or order that would in any way prevent, hinder, or delay any mitigation, response, or recovery action necessary to cope with this emergency.”
During any state of emergency, Florida statutes already provide for specific rule waivers in affected counties. Those waivers include:
- Waiving early refill restrictions
- Allowing for 30-day fills of medication provided that the medication is essential to the maintenance of life or to continuation of therapy related to a chronic condition and the pharmacist determines that any discontinuation of the medication could produce adverse health consequences or discomfort for the patient.
- The pharmacist must document the decision and notify the prescriber in a reasonable time.
- The 30-day fill provision does not apply to Schedule II medications.
- If a refill prescription is presented and the pharmacist is unable to confirm the refill with the prescriber, the pharmacist may dispense an emergency, one-time fill for a 72-hour supply of medication.
Governor Scott’s Executive Order can be found here.
Further details on the waiver of pharmacy rules can be found here.
Governor Nathan Deal issued an Executive Order declaring a state of emergency in several counties. This declaration was recently expanded to 94 counties, which are as follows:
Appling, Atkinson, Bacon, Baker, Baldwin, Ben Hill, Berrien, Bibb, Bleckley, Brantley, Brooks, Bryan, Bulloch, Burke, Calhoun; Camden, Candler, Charlton, Chatham, Chattahoochee, Clay, Clinch, Coffee, Colquitt, Cook, Crawford, Crisp, Decatur, Dodge, Dooly, Dougherty, Early, Echols, Effingham, Emanuel, Evans, Glynn, Grady, Harris, Houston, Irwin, Jeff Davis, Jefferson, Jenkins, Johnson, Jones, Lamar, Lanier, Laurens, Lee, Liberty, Long, Lowndes, Macon, Marion, McIntosh, Meriwether, Miller, Mitchell, Monroe, Montgomery, Muscogee, Peach, Pierce, Pike, Pulaski, Quitman, Randolph, Schley, Screven, Seminole, Stewart, Sumter, Talbot, Tattnall, Taylor, Telfair, Terrell, Thomas, Tift, Toombs, Treutlen, Troup, Turner, Twiggs, Upson, Ware, Washington, Wayne, Webster, Wheeler, Wilcox, Wilkinson and Worth.
Last year the Georgia Board of Pharmacy adopted a policy specific to dealing with public emergencies. In relation to patients receiving prescriptions, that policy states, “… a pharmacist may dispense a 72-hour refill supply of a prescription drug repeatedly to a patient, but in total not more than a thirty (30) day supply, without practitioner authorization if:
- The refill is not for a controlled substance;
- In the pharmacist’s professional judgment, the prescription drug is essential to the maintenance of the patient’s life or to the continuation of therapy;
- The pharmacist makes a good faith effort to reduce the information to a form that may be maintained for the time required by law or rule, indicates it is an “emergency refill prescription,” and maintains the record as required by state and federal law and as required by state and federal disaster agencies for consideration for possible reimbursement programs implemented to ensure continued provision of care during a disaster or emergency;
- The pharmacist informs the patient or the patient’s agent at the time of dispensing that the prescription drug is being provided without the practitioner’s authorization and that authorization of the practitioner is required for future refills; and
- When emergency conditions permit, the pharmacist notifies the practitioner that the refill occurred.”
The policy also allows for temporary licensing pharmacists licensed in another state and allows for temporary or mobile pharmacies under certain conditions.
Governor Deal’s Executive Order can be found here.
Further details on the Public Emergency pharmacy policy can be found here.
Governor Henry McMaster declared a state of emergency in the entire state. His Executive Order mobilizes the National Guard, suspends licensing for security personnel tasked with protecting life and property, and initiates the South Carolina emergency plan. South Carolina statute Section 40-43-170 details changes in pharmacy practices in areas under a declaration of emergency:
- When the Governor issues a "State of Emergency":
- A pharmacist may work in the affected county and may dispense a one-time emergency refill of up to a fifteen-day supply of a prescribed medication if:
- the pharmacist has all prescription information necessary to accurately refill the prescription;
- in the pharmacist's professional opinion, the medication is essential to the maintenance of life or to the continuation of therapy;
- the pharmacist reduces the information to a written prescription marked "Emergency Refill", files the prescription as required by law and notifies the prescribing physician within fifteen days of the emergency refill; and
- the prescription is not for a controlled substance.
- A pharmacist not licensed in South Carolina but currently licensed in another state may in a state of emergency dispense prescription medications in those affected counties without being licensed in South Carolina during the time that a state of emergency exists if:
- the pharmacist has some identification to verify current licensure in another state;
- the pharmacist is engaged in a legitimate relief effort during an emergency situation.
- This disaster preparedness ends with the state of emergency.
Governor McMaster’s Executive Order can be found here.
South Carolina Title 40 can be found here.
Governor Roy Cooper also issued an Executive Order declaring a state of emergency for the entire state. Governor Cooper’s declaration focuses on the coordination of federal, state and local emergency personnel. The North Carolina Board of Pharmacy issued its own alert reminding pharmacies and DME providers to ready their disaster plans. The Board authorized pharmacies and DME providers to follow Rule 21 NCAC 46.1815, which states:
“In the event a pharmacist or device and medical equipment permit holder receives a request for a prescription refill and the pharmacist or permit holder is unable to readily obtain refill authorization from the prescriber because of the prescriber's inability to provide medical services to the patient, the pharmacist or permit holder may dispense a one-time emergency supply of up to 90 days of the prescribed medication, provided that:
- The prescription is not for a Schedule II controlled substance;
- The medication is essential to the maintenance of life or to the continuation of therapy in a chronic condition;
- In the pharmacist's or permit holder's professional judgment, the interruption of therapy might reasonably produce undesirable health consequences;
- The dispensing pharmacist or permit holder creates a written order entered in the pharmacy's automated data processing system containing all of the prescription information required by Section .2300 of these Rules and signs that order;
- The dispensing pharmacist or permit holder notifies, or makes a good faith attempt to notify, the prescriber or the prescriber's office of the emergency dispensing within 72 hours after such dispensing.”
Governor Cooper’s Executive Order can be found here.
The North Carolina Board of Pharmacy notice can be found here.
Our thoughts are with the many team members, associates, family members, customers, and injured individuals that we serve in the southeastern states. If you have any questions about these declarations’ impact on your services, please contact Brian Allen, Vice President of Government Affairs, at firstname.lastname@example.org.