Nashville, Tenn. — October 3, 2024 —
Communities across Tennessee and the southeast region experienced high winds and flood waters recently from the remnants of Hurricane Helene. As the search continues for missing people, rescue and relief workers have been tirelessly helping those in need across many Tennessee communities.
TPA encourages you to keep the families in need in your thoughts and prayers as relief efforts begin to take shape. The Tennessee pharmacy family will find strength in this tragedy. The outpouring of support from TPA members from across the state is nothing but amazing to experience, yet help is needed.
TPA has been consulting with the Board of Pharmacy, and Board staff are certainly aware of the significant public health issues created by this weather emergency. TPA supports your efforts to ensure that patient needs are being met and know that you will use your compassion and good judgment to deal with the crisis. If you need further information from the Board of Pharmacy, you may contact your local inspector or contact Executive Director Lucy Shell at lucy.shell@tn.gov.
What to Know for Your Practice:
On Friday, September 27th, Governor Lee issued this Executive Order to provide relief to victims of the severe weather and flooding in Tennessee. Under item 2 in the Executive Order, Tennessee Code Annotated, Section 630-10-207(a) and (c) are suspended to allow pharmacists to dispense a 30-day supply of a prescription drug without prior authorization to victims of the severe weather. Note this does not apply to controlled substances. This Executive Order will remain in effect until midnight on November 10, 2024.
Dispensing CII prescriptions in an emergency
Pharmacists are reminded that, in the case of an “emergency situation,” federal law (21 CFR 1306.11(d)) allows a pharmacist to dispense a Schedule II controlled substance upon receiving oral authorization from the prescriber, provided that: (1) the amount is limited to that adequate to treat the patient during the emergency period; (2) the prescription is immediately reduced to writing by the pharmacist; (3) if the prescriber is not known to the pharmacist, the pharmacist makes a reasonable effort to determine the oral authorization came from a DEA-registered prescriber; and (4) within 7 days, the prescriber causes a written prescription to be delivered to the dispensing pharmacist.
Delivery to Patients in Need
If you have a patient struggling to obtain their medication in-person or through delivery services, TPA encourages you to contact your local county Sheriff’s office. While the Sheriff’s office cannot serve as a permanent delivery service, they can help identify other possible barriers impacting your patient’s ability to receive their medication and can help triage other services by local, state, and federal authorities.
Emergency Prescription Assistance Program (EPAP) Activated
HHS activated the Emergency Prescription Assistance Program (EPAP) for uninsured Tennessee residents needing medicine after Hurricane Helene. The EPAP helps uninsured patients request a free 30-day supply of certain medications every 30 days while the EPAP is active. Uninsured Tennessee residents affected by the recent hurricane can call the EPAP hotline, 855-793-7470 (TTY 1-800-876-1089), or visit the EPAP website to check their eligibility, determine if their medications or medical equipment are covered, or locate a participating pharmacy. Fact sheets available in English and Spanish.
NCPDP Emergency Override Codes
TPA has provided this FAQ on emergency override codes from guidance from NCPDP.
RxOpen Pharmacy Closures Tracker
RxOpen is a resource that is updated frequently to track which pharmacies in affected areas of disaster are open or closed. Please use this tool to assist patients with finding open pharmacies near them.
What to Know from Third Party Payers:
Resources for TennCare Beneficiaries:
TennCare issued this Pharmacy Provider Notice. Below is a summary of the temporary changes that will be effective in impacted counties starting September 27, 2024, due to severe weather. These changes support the Governor’s executive action (No. 105) to provide relief to victims of severe weather and flooding in Tennessee, which remains in effect until November 10, 2024. Please see provider notice linked above for full details and a guide for override codes and affected counties.
- Prior authorization edits are temporarily suspended.
- Refill-too-soon edits are temporarily suspended.
- ▪ Exceptions: Opioids and other controlled medications. Please call for exception review.
- Fill limits (max of 5 fills) are temporarily suspended.
- DUR: duplicate Rx/duplicate therapy
- Pharmacy lock-in location changes are overridden where applicable. Please call for an exception review.
Resources for TRICARE:
TRICARE has authorized temporary prescription refill waivers for patients in Tennessee due to the impact of Hurricane Helene. TRICARE patients can take their prescription bottle to any TRICARE retail network pharmacy to get a refill, or contact Express Scripts if they do not have access to their prescription bottle/label.
Resources for Medicare Beneficiaries:
The CMS Regional Office has also shared this information during this challenging time. If a Medicare beneficiary has specific service concerns, they may call CMS at 800-MEDICARE (800-633-4227) or reach out to us via email at ROATLORA@cms.hhs.gov. CMS understands that Medicare beneficiaries may have questions about accessing their coverage if displaced and during emergencies. Please refer to the updated document: Getting Care & Drugs in a Disaster or Emergency. It is also available in Spanish: Cómo obtener atención médica y medicamentos en una situación de desastre o emergencia. Here is additional guidance from CMS for healthcare providers on emergency preparedness and response: Healthcare Provider Guidance provided by CMS.
Resources for displaced North Carolina Medicaid Beneficiaries:
CMS has approved an expedited enrollment process, where the pharmacy can be enrolled within 24 hours in NC Medicaid, and claims back to September 25, 2024 will be covered. Please see the bulletin link below for details on how to submit for enrollment. Enrollment should be simple and fast. For pharmacies assisting displaced NC Medicaid beneficiaries, if you have questions or need assistance, please email Medicaid.benefits@dhhs.nc.gov.
- North Carolina’s covered drugs are similar to Tennessee. North Carolina Medicaid has waived prior authorization and the agency is allowing for early refills, by putting in an edit on the claim. Please see the bulletin link below for details. With the disaster edit, the claims will pay.
- Pharmacies are have to dispense prescriptions to Medicaid members, even when the member cannot pay the copay.
- NC Medicaid Preferred Drug List: https://medicaid.ncdhhs.gov/pdl-october-1-2024/download?attachment
NC Medicaid Bulletin October 1, 2024: https://medicaid.ncdhhs.gov/blog/2024/10/01/update-nc-medicaid-temporary-flexibilities-due-hurricane-helene-october-1-2024
Where to Request Aid or Contribute Financially to Disaster Relief
East Tennessee Foundation Fund for Disaster Relief:
While local communities appreciate the volunteer spirit during disasters, please DO NOT send donations that have not been requested by state or local authorities. Do not self-deploy to disaster areas – this will hinder response and recovery operations. A fund with the East Tennessee Foundation has been established for monetary donations for impacted counties.
Additionally, The American Red Cross is assisting with shelters and helping to locate someone across all states impacted.
Resources from National Associations:
If your pharmacy experiences any damage due to this natural disaster, the NCPA Foundation Disaster Relief Fund can help with costs for repairs. Impacted pharmacy owners can apply for a disaster relief grant visit here. Please contact Stephanie Vichness (stephanie.vichness@ncpa.org) at NCPA with any questions.
What else can you do to help?
For any friends, colleagues, or loved ones that need sheltering locations, those can be found on TEMA’s website.
Stay informed as many roadways have been impacted by flooding. Before going out, visit TDOT’s SmartWay website.
TEMA is releasing Flash Reports daily on this website. You can refer patients here to get updates on recovery from the Hurricane.
The Volunteer State will shine through in the wake of this difficult time. Our communities will find hope and heroes amongst the Tennessee pharmacy family!