Stepping Up: The 30-day limit, drug shortages and doing what it takes to protect the drug supply

This blog post originally appeared on Canadian Healthcare Network on April 16, 2020

Controversial, no doubt, but necessary to ensure the long-term medication needs of Canadians

By Christine Hrudka
Chair, CPhA

A month ago, in response to an unprecedented surge in demand for medical supplies and medications as a result of COVID-19, CPhA made the proactive, but necessary, move to recommend that pharmacies adopt a temporary 30-day supply of prescription medication. We didn’t want Canadians to experience what we have seen in news reports from other countries where pharmacies were struggling with shortages due to high patient demand.

At a time when pharmacy staff were already managing increased pressures and demands, moving towards more frequent refills was a measure of last resort that was necessary to protect the long-term needs of Canadians. Pharmacists, however, are still able to apply their professional judgment and, in extraordinary circumstances, can choose to dispense a 90-day supply for clinical and other reasons, such as for rural and remote communities or for extreme financial burdens to the patient.

At the time of our recommendation we understood that a 30-day drug supply would be difficult and pose problems for many patients. That’s why we also explicitly stated that patients should not have to endure any additional financial hardships as a result of this measure to protect Canada’s drug supply. To ensure that patients are not unnecessarily burdened by additional dispensing fees or drug plan copayments, CPhA has been calling for governments and private insurers to protect them against any additional out-of-pocket costs resulting from more frequent refilling of chronic medications due to the temporary 30-day supply recommendations.

Additionally, to alleviate some of the risks associated with more frequent visits, and to support physical distancing, pharmacies across the country are also providing increased deliveries for patients who are not able to leave their homes. Many pharmacies have also implemented special hours for seniors and other at-risk clients to create safer ways to access their pharmacies.

We know that this recommendation been especially hard on pharmacists, too, in terms of handling the avalanche of advice, questions and reassurances to patients, lack of access to PPE and staffing issues, not to mention the work necessary to arrange deliveries to your patients or retrofit your pharmacies to make them safe for all.
As the weeks have gone by, COVID-19 has proven to be and continues to be a threat to Canada’s drug supply and we’ve noticed a number of troubling trends.

The first occurred seven weeks ago, when almost overnight, the supply of masks, hand sanitizer and gloves were sold out. Then, as public health officials started to implement physical distancing policies across the country and recommended that people stockpile food and medications, the demand for medications skyrocketed.

What we saw then was that demand increased by over 200% in March, threatening the integrity of Canada’s drug supply chain. If left unchecked, we would have run the risk of running out of medications for our patients, hence the recommendation for the temporary 30-day supply limit of medications.

We’re also alarmed about an increasing trend in COVID-19 related drug shortages. In the months leading up to March, the government’s mandatory drug shortages website had been listing approximately five new shortages per day. In the past few weeks, that number has risen by about 35% and there are early signals that those shortages have increased more rapidly in the first few weeks of April.

Currently, Health Canada has identified three such COVID-related severe shortages:

Hydroxychloroquine. While there is currently no evidence to suggest that this medication is a cure for COVID-19, the demand is now making it difficult for patients who rely on this drug for conditions like rheumatoid arthritis or lupus.
Inhalers used for asthma and COPD. The demand for inhalers in the last few months has increased significantly for both hospitals, as they prepare for COVID, and in the community setting as people stockpile medications.
Medications used in hospitals, particularly the sedative medications fentanyl and propofol used in intensive care units.

Our pharmacy colleagues around the world are also seeing a rise in demand, prompting the European Commission to call on its member states to ensure that Europeans have access to essential medicines during the coronavirus outbreak. Not surprisingly, they are recommending that its members limit dispensing and sales of certain prescription and non-prescription medicines, for example, only allowing a 30-day supply of prescription medicines, or a maximum of one package per customer of non-prescription medications.

Managing Canada’s drug supply has required an extraordinary level of effort, expertise and care by pharmacy teams under the most difficult of circumstances. Pharmacy professionals across the country continue to work tirelessly to support their patients and their communities and make sure that everyone has equal access to the medication supply.

And for that I am so proud of how, once again, my pharmacy colleagues are stepping up during the pandemic.