April 6, 2020
By Naomi Lopez
States across the country are removing or reducing the artificial barriers that limit the number of skilled healthcare professionals within their borders. Arizona is no exception.
On the heels of exempting certified registered nurse anesthetists (CRNAs, those nurses who provide and support anesthesia services) from an overly burdensome and optional federal health regulation and expanding the use of telemedicine in the state’s Medicaid program, Arizona Governor Doug Ducey has taken additional steps through Executive Order 2020-20, Expanding Access to Pharmacies, to shore up the supply of healthcare providers and further limit potential exposure in healthcare settings.
Reflecting recommendations submitted by the Goldwater Institute and the state’s emergency prescribing laws that are already in place, the pharmacy Executive Order (EO) allows pharmacists to provide emergency refills for maintenance medications for up to 180 days.
Maintenance medications are taken regularly, usually daily, to treat ongoing medical conditions and needs including asthma, diabetes, birth control, cholesterol, arthritis, and high blood pressure and cholesterol. (Controlled substances are not included in this order.)
Not only will this authority for pharmacists further limit the potential exposure to patients and healthcare workers as patients will not need to visit medical offices in person, some providers may be redirecting their time to help support COVID-19 patients, limiting or delaying their availability to their established patients. The order also waives a state permit requirement for the production of hand sanitizer, a product that is now is short supply but is important in the fight against the virus.
The EO also requires that prescribing chloroquine and hydroxychloroquine for COVID-19 purposes be restricted to patients who test positive, present symptoms of the illness, or those who are susceptible to it, such as those at high-risk and frontline healthcare workers. There is some reason to be believe that chloroquine and hydroxychloroquine has promise as a potential treatment for symptoms, as well as serve as a prophylaxis for frontline healthcare workers, but is not yet confirmed by medical evidence.
This is an important step, as it recognizes the importance of having more treatments for those who need it most while also protecting those rheumatoid arthritis and lupus patients who rely on it but are facing pharmacy shortages. As part of the Emergency Use Authorization from the Strategic National Stockpile and a recent FDA authorization that allows compounding pharmacies to make the treatment, the current shortages should resolve soon.
The FDA and CDC are facilitating treatments using this drug for hospitalized patients, and there is now a large-scale clinical evaluation being conducted by the University of Oxford to examine whether this drug, which is also a prophylaxis for malaria and is routinely prescribed for foreign travel, may help protect frontline healthcare workers exposed to sick patients. A double-blind, random trial of 3,000 first responders in Detroit is also being launched.
Freeing up pharmacists is an important step in preparing the state and protecting against the anticipated surge in COVID-19 patients that could strain the healthcare system. Allowing healthcare professionals to practice at the top of their medical education and training, whether responding to the current crisis or as a matter of permanent policy, helps increase the availability of educated and trained healthcare professionals where they are needed most.
Naomi Lopez is Director of Healthcare Policy at the Goldwater Institute.