David Calabrese, Senior Vice President and Chief Pharmacy Officer, OptumRx
No one should ever have to worry about access to prescription medication, especially not during a global pandemic. That’s what David Calabrese, senior vice president and chief pharmacy officer at OptumRx, and his entire team think. So, they have been working to ensure all members can get the medications they need when they need them.
This means putting the proper processes and procedures in place so that not only those impacted by COVID-19 — but all members — have reasonable access to their prescriptions.
It also means ensuring the drug supply is strong.
“Our job is to make sure that we are doing everything possible so that members don’t have to worry about their drug benefits,” Calabrese says. “We are monitoring any drug shortages so we can move fast and ensure the care members receive is not interrupted.”
Factors contributing to potential drug shortages
Shortages of certain medications have been a common thread since the beginning of the health crisis, and those shortages are due to several factors. The first is demand for certain products that have been used to treat patients with the virus, like respiratory medications, pain medications, antibiotics and anesthesia medications.
“Another factor is access to raw materials,” says Calabrese, stating that 50% of the world supply of raw materials shipped to drug manufacturers come from China. What’s more, India produces a large supply of the world’s generic drugs. “Facility closures and labor shortages in China and a limit on the external distribution of some drugs from India definitely have impacted availability.”
Finally, a few medications like hydroxy-chloroquine and chloroquine were both touted as possible treatments for COVID-19, which caused a significant impact on the availability of these medications.
“While some shortages have been resolved, we continue to collect information from a number of sources to identify potential issues in the supply chain,” says Calabrese.
Keeping a finger on the pulse of the supply chain
Those sources are varied. Each provides different types of information — data that could signal issues with a supply.
For home delivery operations, it’s about the actual supply on hand for a particular drug. Retail and specialty pharmacies provide procurement information and drug manufacturers indicate whether or not they are experiencing supply issues related to raw materials.
“We also look to our own internal member services help desk to see if they are getting calls relative to shortages on specific products,” says Calabrese. “Often, it’s these calls, these insights that give us information on any given drug.”
From this information, potential next steps can be determined to mitigate potential shortages.
“We might utilize our in-house clinical resources to determine if there are drugs that might serve as alternatives — therapies that work equally well from a clinical perspective, that are equally as safe, and equally as accessible in terms of the economics,” says Calabrese.
Following guidance from the Centers for Disease Control (CDC), dosage limitations can be set to preserve supply.
Calabrese says changes can also be made to help members transition a prescription to a home delivery operation or another service. Formularies can be changed to allow access to brand-name versions of in-demand medications when generics are in short supply.
Click here to read a recent blog post on how pharmacy benefits policies were adjusted to ensure people could fill their prescriptions during the COVID-19 crisis.
Impacts beyond shortages
While potential drug shortages are one by-product of COVID-19, Calabrese says tracking the supply chain revealed another, equally critical by-product: a decrease in prescriptions being filled.
“The concern that raises for me is that patients aren’t seeking wellness care, or they’re bypassing access to their physicians and are trying to manage those things on their own,” he says.
As a result, Calabrese is concerned that many patients, particularly those who are elderly, may not be managing their conditions appropriately. If they stop taking medications for chronic conditions, it could increase their risk for a more severe state of illness.
In this video, Calabrese says they are doing everything possible to ensure members have access to medications.
“Members are afraid, and we need to ensure that we surround everyone with support so that they can comfortably access the pharmaceuticals, medical technologies and clinical capabilities that they need during this difficult time,” says Calabrese.