Coronavirus preparedness: Insurers and Medicaid need to relax prescription refills

Coronavirus preparedness: Insurers and Medicaid need to relax prescription refills
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There is widespread agreement that a pandemic of coronavirus strain COVID-19 is coming. In finance, Moody’s most recent analysis puts the likelihood of a pandemic at 20 percent to 40 percent. In government, Dr. Nancy Messonnier, Director of the National Center for Immunization and Respiratory Disease within the CDC, said, “It’s not so much of a question of if this will happen anymore but rather more of a question of exactly when.”

Health Secretary Alex Azar acknowledges that this is a public health emergency. In academia, non-government scientists like Harvard epidemiologist Dr. Mark Lipsich have stated that 40-70 percent of the global population will be infected — though not all will be seriously ill.

In response to this consensus, the Department of Homeland Security has issued preparedness guidelines at Ready.gov.  This “pandemic prophylaxis” list calls for stockpiling a 2-week supply of water and food, having medical records readily available, discussing preparations for illness with family members, and obtaining “a continuous supply in your home” of prescription medications.

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But Medicare, Medicaid, and most commercial insurance plans refill most prescriptions once a month. At your average pharmacy, you cannot get your 30-day refill until day 28. To comply with its own recommendations, it is absolutely essential that the administration relaxes restrictions on prescription refills as soon as possible and changes the default from one month to a two month supply.

With all the attention focused on avoiding coronavirus, we are neglecting to address the challenges a pandemic creates for other diseases. Imagine the man-made needless suffering, morbidity, and mortality that will result if access to chronic critical medications was limited during a crisis

Common diseases where medication is absolutely critical include diabetes (especially insulin-dependent) affecting 12-14 percent of the population, asthma (about 8 percent), and severe mental illness (about 4.5 percent). Now add in all the other people with chronic diseases requiring daily medication such as high blood pressure (about 30 percent), HIV and cancer. This represents well over 100 million people, a large portion of whom, based on age and other medical problems, are also among the most susceptible to COVID-19 

Medicare does offer an extended-day supply option for some but finding out whether your plan includes this option and what pharmacies accept it is difficult and requires doctors and pharmacies to negotiate with the government on a case-by-case basis.

This issue is bipartisan but not without ethnic and socioeconomic disparities. While the wealthy can always afford to buy a second month’s medication supply out of pocket, this option is generally not available for those less affluent, especially given the current high drug prices

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Instead of expecting patients to pay out-of-pocket or to negotiate an extremely intimidating system of government and pharmaceutical bureaucracy, Medicare and Medicaid restrictions must be relaxed and extended-day supplies rendered automatic at all network pharmacies, to allow individuals on chronic critical medications to stockpile a 2-4 week supply against this disaster — even if they are not yet due for a refill. Hopefully, private insurers will do the same. 

The evidence regarding COVID-19 management so far indicates that a pandemic will likely result in the closure of schools and stores along with quarantining of people in their homes. Drug shortages may arise nationally because of difficulty obtaining medication or ingredients from abroad or perhaps locally because a pharmacy is closed, transportation is restricted, or the pharmaceutical supply chain is interrupted. 

Small towns that have only one pharmacy and large urban areas, where population density increases the likelihood of sequestering residents at home are especially vulnerable. 

The administration needs to allow stockpiling of critical prescription medicines for millions of citizens in order to implement its own, and in our opinion sensible, recommendations regarding preparation for a pandemic.

To be sure, there will be upfront costs as a result of extending prescriptions, but they are small compared to the costs that would arise from the emergency health care that will be necessary for the midst of a pandemic when the public health system can least tolerate the burden. Specifically, the seizures, strokes, diabetic ketoacidosis, angina, psychosis, and overwhelming infections that will arise from millions of people unable to take necessary medications will result in skyrocketing costs and potentially overwhelm an already overburdened health care system.=

Of course, there are some medications, such as opioids or other controlled substances, for which the cure may be worse than the disease should these extra medications be sold on the black market by unscrupulous people. Separate guidelines can be created for these classes of drugs.

The White House, which seems preoccupied with the impact of COVID-19 on the stock market, would do well to address this issue and avoid scientifically unfounded claims such as those from White House Economic Adviser Larry Kudlow who said, “We have contained this”. By acting now, the administration would significantly reduce the health, suffering, and socioeconomic consequences of a COVID-19 pandemic. 

In the Book of Genesis, Joseph and the Egyptian government he represents save civilization by simply stockpiling in times of plenty against the fast-approaching times of famine. If we allow people additional access to certain critical medicines outside of the normal refill cycle then we will exemplify disaster health preparation, and perhaps, health management to the world.

In the more recent literary work, “Love in the time of cholera,” Gabriel García Márquez wrote, “wisdom comes to us when it can no longer do any good.” We have a chance now to disprove this adage. There is no downside to addressing this issue and no excuse for not doing so. 

Dr. Michael Rosenbaum is a professor of pediatrics and medicine at Columbia University Irving Medical Center and a practicing pediatrician in New York City. Dr. Beth Simone Noveck is a Professor and Director of the Governance Lab at New York University’s Tandon School of Engineering. She was the United States Deputy Chief Technology Officer and led the Open Government Initiative during the Obama administration.