Key drug manufacturing facilities in China were sidelined by the
COVID-19 outbreak. How will it affect Americans?
Due to disruptions in China and India drug
supply chains caused by the COVID-19 pandemic, employers are rightfully
concerned that their workers might not have ready access to medications,
according to a Willis Towers Watson expert.
But now there is some encouraging news about
the availability of ingredients from China – at least to make pain relievers,
anticoagulants and antibiotics, Nadina J. Rosier, the firm’s managing director,
health and benefits consulting, writes in blog post.
“Many drug manufacturing sites in China are
reporting they are back online after initial disruptions, with some at full
capacity and others operating between 50 percent and 80 percent capacity,”
Rosier writes. “This is reassuring news in the hope that the integrity of the
pharmaceutical supply chain remains intact, but the situation requires diligent
monitoring by insurers as the virus spreads to other locations and concerns
around stockpiling remain.”
Still, 20 drugs likely remain on the
unpublished primary FDA drug shortage list, whose ingredients or the entire
drug itself is manufactured in China, she writes. Moreover, India officials
announced that the country was restricting exportation of ingredients, such as
metronidazole, erythromycin, clindamycin and some of the drugs that are made
from them.
“Employee stress about drug shortages can have
an adverse impact on their overall wellbeing and productivity,” Rosier writes.
“The good news is that health plans and pharmacy benefits managers are
leveraging disaster preparedness policies and previous triggers for other
notable shortages (e.g., Epi Pen shortage).”
In the meantime, employers can work with
vendors to monitor impact and ensure access to their medications. First, they
should evaluate current “refill too soon” limits and consider temporarily
relaxing thresholds in anticipation of any drug shortages or member quarantine.
“We don’t advise that employers eliminate the
threshold entirely as stockpiling can lead to worsening drug shortages, but
reducing the limit threshold can ease the minds of employees,” she writes.
“Waste can also result from stockpiling medications, as drugs have expiration
dates, and some have a very limited shelf-life. This type of unused medication
waste can add up to billions of dollars each year.”
Employers should also continue to encourage
employees and their families to fill 90-day supplies of chronic medications, to
help ensure that they will have enough supply on hand in case of a shortage or
quarantine. Some PBMs are also allowing for an emergency 14-day supply for
members who may live in impacted emergency areas where self-containment is
required or strongly suggested.
“Employers should work with their PBMs to
establish protocols that allow for dispensing of medication in a timely manner,
including alternative delivery arrangements as needed,” Rosier writes.
Employers should also prepare to potentially
relax utilization management criteria in case of quarantine. Willis Towers
Watson recommends that employers, in collaboration with their PBMs, relax
required prior authorization criteria that would otherwise mandate testing for
those members that may be impacted by a quarantine or self-containment.
Finally, employers should work with their PBMs
to make formulary exceptions more readily available, she writes. “As many
employers have implemented more restrictive formularies to contain costs,
employers may want to allow for access to alternative medicines that would
normally be considered ‘tier 3’ or ‘non-preferred’ to be provided at a reduced
or ‘tier 2’ out-of-pocket cost, in the event the initial drug experiences a
shortage and is not available,” Rosier writes.
Employers are also asking about COVID-19
treatments and whether a vaccine “is in sight.” The National Institutes of
Health has selected the Kaiser Permanente Washington Health Research Institute
to launch the first investigational clinical trial to test a possible
coronavirus vaccine. In addition, the World Health Organization is helping to
accelerate research and development efforts with a range of partners.
“Several treatments have been used to help
individuals manage the symptoms of COVID-19, including anti-pyretic and
analgesics such as ibuprofen, antitussives and anti-asthmatics for those with
the underlying disease,” Rosier writes. “Scientists and researchers continue to
investigate potential treatments, a combination of new and repurposed drugs,
including some that currently treat HIV and hepatitis C.”
For example, an experimental drug Remdesivir
is currently being tested for COVID-19. Lopinavir/Ritonavir (brand name Kaletra
or Alluvia) are also being tested to target various parts of the new
coronavirus.
“While neither is an FDA-approved treatment
for COVID-19, employers that sponsor a health-savings-account-qualifying
high-deductible health plan may cover testing for COVID-19 without any
cost-sharing or reduced cost-sharing,” she writes. “Some employers have been
seeking guidance around the implications of first-dollar coverage and
eliminating out-of-pocket costs for COVID-19 testing and treatment.”
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