Texas Pandemic Influenza Regional Conference Antiviral Medication Distribution

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Texas Pandemic Influenza Regional
ConferenceAntiviral Medication Distribution
Texas Department of State Health Services
(DSHS) And Texas Division of Emergency Management
(DEM)August and September, 2009
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Presentation Outline

• What is an antiviral medication?
• Brief Overview of Clinical Guidelines
• Differences between Antiviral Medication
  Vaccine
• Strategic National Stockpile Overview
• State Stockpile
• Overview
• Access
• Distribution
• Reporting
• Supply Chain Disruption
• Key Points
• Considerations

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Antiviral Medication What Is An Antiviral
Medication?

• A medication that has activity against influenza
  viruses, including the novel H1N1 influenza virus
• Can be used to treat or help prevent novel H1N1
  influenza
• Is only appropriate in specific circumstances
• Requires a prescription from a healthcare
  provider
• Is just one component of a comprehensive
  containment and treatment plan to help control
  novel H1N1 influenza

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Antiviral Medication Brief Overview of Clinical
Guidelines

• Treatment
• Must be used within 48 hours of onset of symptoms
  for maximum effectiveness
• Should be targeted to high risk populations
• Pregnant women, children, adults with chronic
  diseases (such as asthma, COPD, and diabetes)
• Patients hospitalized due to novel H1N1 influenza
• Healthcare providers should follow guidance from
  DSHS found at www.texasflu.org
• Antiviral medications can sometimes be used for
  preventive treatment in limited situations

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Antiviral Medication Differences between
Antiviral Medication and Vaccine
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Antiviral Medication Strategic National Stockpile
Overview
What is the Strategic National Stockpile?
Q
The Strategic National Stockpile (SNS) is a
federal government stockpile of medicine and
medical supplies available to states for public
health emergencies upon request by state officials
A

• For pandemic influenza response, Texas receives a
  finite amount of antiviral medications from the
  SNS.
• The SNS includes two types of antiviral
  medications Tamiflu and Relenza.

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Antiviral Medication State Stockpile Overview
What is the State Stockpile?
Q
A stockpile of antiviral medication DSHS
purchased from federal preparedness funds and
state legislature funds antiviral medication
received as the Texas portion of the federal
Strategic National Stockpile
A

• The state stockpile includes materials received
  from the SNS
• The state stockpile has a finite amount of
  antiviral medications that need to be used
  strategically
• The state stockpile includes two types of
  antiviral medications - Tamiflu and Relenza

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Antiviral Medication State Stockpile Overview
When will the State Stockpile Be Used?
Q

• There are three primary purposes for the state
  stockpile
• Individuals who cannot access medication through
  routine channels
• Public health measure needed for outbreak control
• Routine supply channels breakdown

A
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Antiviral Allocation and Distribution Routine
Channels for Access to Medication for Patients
Access to Antiviral Medications for Patients
Healthcare provider determines if an antiviral is
appropriate
Healthcare provider writes prescription
Pharmacist fills prescription
Routine Channel for Patients
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Antiviral Allocation and Distribution Access to
State Stock Medication for Patients

• Uninsured and underinsured may not utilize
  routine channels due to cost
• DSHS created a mechanism to serve these patients
  through the state stockpile where patients can
  access medication at low or no cost based on the
  patients need
• This mechanism uses a pharmacy distribution
  network that includes
• Retail chain and independent pharmacies
• Community Health Center (CHC) / Federally
  Qualified Health Center (FQHC) pharmacies

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Antiviral Allocation and Distribution Access to
State Stock Medication for Patients
Access to State Stock Antiviral Medications for
Specific Patients
Healthcare provider identifies state stock is
needed
Healthcare provider writes prescription
Healthcare provider determines antiviral is
appropriate
Pharmacist fills prescription from state stock
Health Care Provider refers patient to a pharmacy
that has state stock
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Antiviral Medication Public Health Measures to
Address Outbreak Control
Local Health Departments

• Local health departments addressing public health
  outbreak control can access the state stockpile
  if local supplies are nearing or at depletion.
• The local health department should contact the
  health service region to make this request.

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Antiviral Allocation and Distribution Routine
Supply Channel for Health Care Entities
Access to Antiviral Medications for Health Care
Entities
Medication supply runs low
Order from supplier
Treat patients
Routine Channel for Health Care Entities
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Antiviral Allocation and Distribution Routine
Supply Channel for Health Care Entities
Access to Antiviral Medications for Health Care
Entities
Medication supply runs low
Order from supplier
Treat patients
Routine Channel for Health Care Entities
If routine supply channels break down, the Health
Service Region has a mechanism to provide
supplies to health care entities.
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Antiviral Allocation and Distribution Distribution
System for State Stock Antiviral Medication
DSHS
DSHS Health Service Region
Chain Pharmacies
Independent Pharmacies
FQHCs / CHCs
Local Health Departments
Healthcare Systems
Uninsured/ Underinsured Populations
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Antiviral Medication Reporting

• DSHS will track state stock antiviral medication
  usage and inventory levels.
• Entities receiving state stock of antiviral
  medications will be required to report individual
  usage data and inventory levels to DSHS on a
  regular basis through an electronic system.

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Antiviral Medication State Stockpile Utilization
Summary

• For individuals who are uninsured or
  underinsured, antiviral medications can be
  distributed from the state stockpile
• Healthcare providers will have information about
  how to access the state stockpile for patients in
  need

Uninsured and Underinsured

• When required, the state stockpile can be used
  for outbreak control when deemed a necessary
  public health measure by either the DSHS Health
  Service Region or local health department

Outbreak Control
Supply Disruption

• Used to meet immediate health care entity needs
  to due to supplier disruption or unavailability

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Antiviral Medication Complete Supply Chain
Disruption
What happens if the supply chain is completely
unavailable ?
Q

• DSHS will review epidemiological information at
  that time
• DSHS will revise treatment guidance if necessary
  to determine appropriate allocation of the
  remaining stockpile

A
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Antiviral Medication Key Points

• Antiviral medications are appropriate only in
  specific circumstances
• There are a finite number of antiviral
  medications available
• Healthcare providers determine appropriateness of
  antiviral medication for patients
• Healthcare providers should make their decisions
  based on the guidance found at www.texasflu.org
• Antiviral medications are not a substitute for
  vaccine
• Seek seasonal influenza vaccine as soon as that
  vaccine is available
• Antiviral medications are just one component for
  controlling a novel H1N1 influenza virus outbreak
• Non-pharmaceutical interventions (hand washing,
  social distancing, staying home from work/school
  when ill) are key elements to reduce transmission

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Antiviral Medication Considerations
Department of State Health Services
Local Communities

• Manage state stock antiviral medication
  distribution (allocate, process orders, ship)
• Coordinate with stakeholders (health care
  providers, pharmacy partners, etc.) regarding
  state stock antiviral medication distribution
• Provide clinical treatment guidance at
  www.texasflu.org
• Track and report state stock antiviral medication
  usage

• Guidance is available at www.texasflu.org
• Use non-pharmaceutical interventions (hand
  washing, staying home when sick, etc.) to reduce
  transmission
• Ensure continuity of operations plans do not rely
  on long-term antiviral medication for healthcare
  workers and first responders
• Entities who receive state stock antiviral
  medications report on usage of this medication