April 7, 2020
MPA Statement on Prescribing and Dispensing Hydroxychloroquine
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The use of hydroxychloroquine (HCQ) in COVID-19 patients is a rapidly evolving area. Current evidence suggests that HCQ may have benefits in treating patients with detectable COVID-19 virus. Pharmacists have an ongoing obligation to dispense HCQ to patients that were receiving the drug for FDA approved indications previously, such as lupus and rheumatoid arthritis.
 
Without the benefit of specific regulatory guidance, the Michigan Pharmacists Association (MPA) recommends that HCQ only be prescribed for patients with confirmed viral infections or, if the prescriber determines to be appropriate, a presumptively positive patient. MPA recognizes pharmacists must use their professional judgement and defer to the prescriber regarding individual patient decisions, and that HCQ is being prescribed for a legitimate medical purpose associated with the Covid-19 virus based on currently available information. HCQ is listed on the FDA’s drug shortage list and, therefore, may be compounded. Prescriptions for HCQ for the purpose of stockpiling or hoarding should be refused.
 
Individuals may want to listen in to the virtual Board of Pharmacy Meeting ( April 8, 2020 Board of Pharmacy Agenda ) as the Board discusses HCQ tomorrow, Wed., April 8, 2020, beginning at 10 a.m. To listen in on the meeting, dial 877-820-7831, when prompted, please enter the following conference ID: 973313
DEA Form 222 Exemption During the COVID-19 Crisis 
Recently, the DEA has made two temporary exceptions to the rules around oral emergency prescriptions for schedule 2 drugs. The major changes are below:

  1. The prescriber will now have 15 days to deliver the original prescription. 
  2. The prescriber will be allowed to send the follow up prescription via fax, through a photograph or scan of the original prescription in lieu of the paper prescription.

The prescription must still contain all information required of a schedule 2 order no matter how it is submitted.
FDA Provides Clarification on Drug Compounding
The FDA has issued new guidance that include:
  •  FDA will not be enforcing the one-mile radius requirement from the FDA 2016 Hospital and Health System Compounding Draft Guidance.
  •  FDA will not be enforcing the 5 percent limit on interstate distribution of compounded drugs until after the draft Memorandum of Understanding with a state takes effect.
  • Clarified which drugs it designates as not “commercially available,” meaning that these drugs can be compounded by 503A and 503B pharmacies.
CDC Guidance to Pharmacies and Recommendations on Vaccinations During COVID-19
The CDC released information regarding vaccinations. The recommendation is no vaccines, except where noted for pediatric patients and limited clinical face-to-face services. Please take a moment to review the attached document for valuable links with the directives and additional information.
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American Epilepsy Society Comment on Therapeutic Substitution of Medications
The American Epilepsy Society (AES) strongly encourages pharmacists to make every effort to keep patients with epilepsy on their current regimen of antiseizure medications (ASM). Pharmacists should consult with the patient’s prescriber/healthcare provider prior to making any therapeutic substitution of ASM.

Generic substitution of ASM has been shown to be safe and is appropriate for patients with epilepsy. While the AES appreciates efforts to ensure patients receive medications during the COVID-19 crisis, there are important concerns for individuals with epilepsy that make therapeutic substitutions of ASM less than optimal and possibly harmful. For many patients with epilepsy, it is very difficult to balance seizure control with adverse effects and drug-drug interactions of ASM. Additionally, ASM have a wide range of mechanisms of action, pharmacokinetics, adverse effect profiles and drug interactions. While almost all ASM have similar FDA approved indications, individual patients with the same seizure classification may have very different clinical responses to the same medication. In addition, many patients require multiple adjustments of ASM, particularly when given in combination, to achieve optimal outcomes.
Helping Emergency Responders Overcome Emergency Situations (HEROES) Act Introduced
Congressman Bill Huizenga has introduced the Helping Emergency Responders Overcome Emergency Situations (HEROES) Act. The act would provide a four month federal income tax holiday to “Qualified First Responders”. This includes law enforcement officers, corrections officers, firefighters, EMT’s, paramedics, pharmacists , nurses, nurse practitioners, physician assistants, hospital and licensed medical facility support staff, and senior care facility staff. MPA has already reached out to the Congressman’s office to include pharmacy technicians in the bill and has assurances that their absence was a minor oversight and that they will begin looking at a way to include pharmacy technicians immediately. If the bill passes, qualified individuals wouldn’t be required to pay federal income tax on the first $150,000 made, up to $12,500 per month for four months. Huizenga plans to formally introduce the bill the next time Congress meets later in April.
Face Coverings:
Frequently Asked Questions
The Michigan Department of Health and Human Services recommends that Michiganders wear a face covering when outside of their home to help stop the spread of coronavirus disease 2019 (COVID-19). Attached is information you can have on hand or share via social media for your patients, family and friends.
MPA Screens Legislators Before Entering Session
The Michigan Legislature is convening today to deal with matters of the state as it pertains to COVID-19. MPA was there to serve as health screeners before members of the legislature could enter the session. Thank you to MPA member Alex Mchawrab, MPA COO Dianne Malburg, PSI Insurance Agency Manager Ron Devers and MPA Government Affairs Manager Brian Sapita for assisting in this process.
NACDS Begins Airing Ad that Highlights Pharmacists
“Rise,” a 30-second ad by NACDS, captures the spirit and resolve of member companies, their teams, their patients, their communities and our nation – amid COVID-19 and throughout time.
Michigan Seeking Qualified Volunteers
Pharmacists, student pharmacists and pharmacy technicians are needed to volunteer to assist in the dispensing process at TCF center (previously known as COBO hall) in Detroit. If interested contact MPA Director of Emergency Preparedness Farah Jalloul or register at www.michigan.gov/fightcovid19.
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SHARE YOUR STORY WITH US
Print this sign, take your picture and post on social media with your story and tell us how you are making a difference during COVID-19. You can also email your photo and story to MPA Communications Manager Jamie James.