COVID-19 Resources for Community Pharmacists

Texas community pharmacists are on the front lines of providing care and guidance to patients during the coronavirus crisis. Patients are counting on their local pharmacists and other health-care providers to share sound, factual guidance about the symptoms and spread of this disease.

Below are resources that can be helpful to pharmacists and patients as we continue to learn more about this pandemic. Please return often to this page for updated information and resources.

Texas State Board of Pharmacy Coronavirus Updates

Emergency Adoption & Procedures

Abbott Says Pharmacy Technicians Can Take on More Responsibility

Governor Greg Abbott has temporarily waived certain regulatory requirements to increase the job capacities of pharmacy technicians and pharmacy interns. Under the Governor's waiver, pharmacy technicians can now accept prescription drug orders over the phone -- a responsibility typically reserved for pharmacists. The Governor's waiver also allows pharmacy technicians to transfer or receive a transfer of original prescription information on behalf of patients. These two waivers can be utilized at the discretion of pharmacists. Additionally, Governor Abbott has waived certain regulations allowing pharmacy interns to assist pharmacists without the designation of preceptor.

The Governor has waived the following rules:

§283.5 -- The Office of the Governor has temporarily suspended the requirement for board approval as a preceptor to supervise a pharmacist-intern performing pharmacist duties of board rule 283.5(a)(1).

§291.32 -- The Office of the Governor has temporarily suspended the requirement that only a pharmacist may receive oral prescription drug orders and reduce the orders to writing, and transfer or receive a transfer of original prescription information on behalf of a patient of board rule 291.32(c)(2)(A), (K) to allow these duties to be performed by pharmacy technicians.

TDI Issues Rule in Response to Alliance Request

At the end of March, the Alliance staff requested rules changes from the Texas Department of Insurance (TDI) in order to help patients and frontline pharmacy providers. The Alliance announced Thursday, April 2 that TDI responded by issuing an emergency rule consistent with our requests.

The emergency rule will make it easier for Texans with TDI-regulated health insurance to get early refills and to get prescriptions at more locations, including by home delivery, so patients have uninterrupted access to prescriptions. Specifically, the rule requires health plans regulated by TDI to:

  • Pay for a 90-day refill of covered medications regardless of when the prescription was last refilled, unless specifically prohibited by law as in the case of controlled substances.
  • Allow prescriptions to be filled at out-of-network pharmacies at no additional cost to the consumer if the drug isn't available quickly through mail order or at an in-network pharmacy within 30 miles.
  • Allow for substitutions if the plan's preferred drug isn't available due to shortages or distribution issues.
  • Waive any requirement for a consumer's signature unless specifically required by law.

We appreciate TDI's quick response to our request. If you have any issues with PBMs following the new emergency rules, please contact [email protected] and/or TDI immediately for resolution.

Hydroxchloroquine Approved by FDA for Emergency-Use of COVID-19

As a reminder, Hydroxchloroquine has been approved by the FDA for emergency-use for COVID-19. The medication can be dispensed if the patient has tested positive to COVID-19, the drug is dispensed for a short duration, and is under the care of a physician.

Hydroxchloroquine has been determined to be in short supply so it may be compounded by state licensed pharmacies. On March 25 the FDA released the following statement,

"The FDA added hydroxychloroquine sulfate to category 1 under the Interim Policy on Compounding Using Bulk Drug Substances Under Section 503B of the Federal Food, Drug, and Cosmetic Act. The FDA does not intend to object to registered outsourcing facilities using hydroxychloroquine (or chloroquine phosphate, which was already on category 1), to compound human drugs provided the drugs meet other conditions and requirements in the FD&C Act...The FDA is placing hydroxychloroquine sulfate on category 1 after it reviewed the nomination and determined there was sufficient information for the agency to evaluate the substance for outsourcing facilities to use in compounding. When FDA categorized hydroxychloroquine sulfate it did not change its approach, but we prioritized this substance due to the COVID-19 pandemic. There are currently no FDA approved therapeutics or drugs to treat, cure or prevent COVID-19; however, there are FDA-approved treatments that may help ease the symptoms of COVID-19. Additionally, state-licensed pharmacies and federal facilities that compound drugs under section 503A of the FD&C Act may compound drugs using hydroxychloroquine sulfate or chloroquine phosphate bulk drug substances because they are components of an FDA-approved drug, provide other requirements in the Act are met." See notice

PBM Rule Exceptions Summary Now Available

Pharmacy First has developed a list of PBMs who have provided exceptions that are being made due to the COVID-19 Pandemic. These exceptions are included but not limited to relaxing patient's signature requirements when dispensing/delivering medications. See summary of changes.

Resources for Small Businesses

The U.S. Small Business Administration has created a webpage with resources for small businesses, including information about the waiver for hand sanitizer approval and about disaster assistance and loans available to businesses. You can also find updates on revised IRS deadlines for tax filing.

Paycheck Protection Loan Program

Our partner, Live Oak Bank, is participating in the Paycheck Protection Loan program. We are not ready to take applications, but you can sign up to be notified as soon as we are. Once the U.S. Small Business Administration (SBA) releases details and guidance on the Paycheck Protection Program, Live Oak will be providing these loans.

As you know, the federal government has made over $350 billion available to small businesses, through the Small Business Administration during this difficult time. As the nation's number one SBA lender* we are monitoring this situation and are poised to offer support and distribution of these funds as soon as the bill is approved.* #1 SBA 7(a) lender by dollar amount for FY2019. The data supplied by the SBA reflects 7(a) gross loan approvals during FY 2019.

In the interim, we are presenting you the facts around both the Economic Injury Disaster Loan (EIDL) and the proposed Paycheck Protection Program (PPP) as of 3.27.2020. It is our hope we can help small business across the country move swiftly towards getting the money they need. 

It is extremely important to understand the SBA guidelines have not been finalized which we hope will be next day or so; however, we have created a sign-up form for interested small business owners to enter into the que for these loans. Once the SBA has finalized their guidance, we will begin to process those who have signed up.

Link to Sign-Up

Additional information: 
U.S. Chamber of Commerce Small Business Checklist
Live Oak Paycheck Protection Program
Live Oak Small Business Loan Options

Coronavirus Websites from Key Government Agencies & Associations

Do You Need Additional Help in Your Pharmacy from a Pharmacy Student?

We understand in other states some independent pharmacists are left to work alone because their staff are out with illness or lack of childcare. In an effort to stay ahead of the curve, Will Douglas, Texas House Republican candidate and pharmacist, has been working with schools of pharmacy, Texas State Board of Pharmacy, Texas Pharmacy Association and the Alliance to activate pharmacy students for pharmacies in need of additional staff.

The UT Tyler Ben and Maytee Fisch College of Pharmacy, in coordination with other schools of pharmacy, has developed a needs assessment survey for independent pharmacies to help match students with pharmacies Here is the link: Community Pharmacies - COVID-19

We understand TSBP is working on provisions for those pharmacies that don't have a preceptor. Please complete the survey if you have a need for additional help.

Best Practices for Community Pharmacists

NCPA has created a "Best Practices" chart explaining how patients with various levels of symptoms and risk should be approached: https://www.covidbestpractices.com

Express Scripts Suspends Desk Audits

Express Scripts, which suspended all network pharmacy field audits earlier this month, announced Monday that it was suspending desk audits as well. This suspension of claims audits does not apply to fraud, waste and abuse investigations or other exceptions that may be required by law. 

FDA Relaxes Hand Sanitizer Rules

The FDA announced last week that they will take no enforcement action against licensed professionals, like pharmacists, who make and sell hand sanitizer as long as they use high-quality ingredients and follow the FDA rules. Your patients need ways to mitigate their own risk and the normal distribution system is failing them. Here's a chance to calm their fears and demonstrate how community pharmacy can adapt in a crisis. NCPA has received multiple questions about this guidance, including how to obtain necessary ingredients and the allowance for flexibility in formulas. NCPA is seeking further clarity plus FDA has offered the following email address to pose specific questions:[email protected].

How Can Alliance Members Help?

  • Provide services (i.e. prescription delivery, drive through, curbside service) to allow patients and staff healthy while maintaining social distancing, thus minimizing disease transmission.
  • Consider providing your compounded hand sanitizer to police and fire stations to assist your community first responders.
  • If an outbreak is identified in your area, work with local health departments to see what you can do to assist. Once a vaccine is developed, independent pharmacies are perfectly positioned to aid in mass immunization. Have supplies ready for those immunizations.
  • Utilize collaborative practice arrangements to keep emergency rooms and clinics clear for truly meaningful cases.
  • Reach out to your legislators and encourage them to put measures in place to use pharmacists in point-of-care testing, such as flu or strep, which will aid prescribers in triaging patients for such future outbreaks.
  • We have developed an Action Plan/ Took Kit for pharmacies to provide information to patients and best practices for your pharmacy.