Frequently Asked Questions about COVID-19

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General FAQs

1) What is COVID-19?

The Centers for Disease Control and Prevention and the World Health Organization (WHO) are actively monitoring the outbreak of a new coronavirus strain called COVID-19, short for “coronavirus disease 2019,” which causes respiratory illness. The virus, which has infected thousands of people worldwide and caused deaths, originated in Wuhan City, China. As of March 11, 2020, the World Health Organization has declared the situation a pandemic. Additional cases have now been reported in the United States.

2) What are the symptoms of COVID-19?

According to WHO, common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure, and even death. People with heart and lung disease or weakened immune systems, as well as infants and older adults, are at higher risk for upper and lower respiratory tract illness.

3) How is COVID-19 spread?

Human coronaviruses are usually spread from an infected person to others through the air by coughing and sneezing and through close personal contact, such as touching or shaking hands.

4) How can we prevent the spread of coronavirus?

The CDC recommends the following precautions be taken to help slow the spread of coronaviruses:

  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth.
  • Stay at home when you are sick, except to get medical care, and avoid visiting crowded places.
  • Cover your mouth and nose when you cough or sneeze.
  • Wash your hands often with soap and water for at least 20 seconds, especially after you have been in a public space, before eating, after blowing your nose, coughing or sneezing.
  • If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol.
  • Clean and disinfect objects and surfaces you touch.
  • Follow all travel guidelines by the CDC.

5) What is the CARES Act, and how will it affect my business?

The Coronavirus Aid, Relief and Economic Security (CARES) Act of 2020 was signed into law on March 27, 2020. The law allocates $350 billion to help small businesses (those with 500 or fewer employees) during this challenging time. The U.S. Chamber of Commerce has created a Small Business Guide and Checklist to provide information about the CARES Act to eligible businesses.

Pharmacy Related FAQs

1) The U.S. Centers for Disease Control and Prevention (CDC) is advising that plan members should ensure their prescriptions are filled. Do pharmacy benefits plans allow early refills?

It is recommended that members continue taking their medications as prescribed and, for those whose plans allow it, obtain their next prescription for a 90-day supply. Consultants should check with their clients’ PBMs to determine how “refill too soon” requirements are being managed.

Presently, the three largest PBMs that cover the majority of Americans’ pharmacy benefits (CVS/Caremark, Express Scripts, and OptumRx) have leveraged their State of Emergency solution to allow certain “refill too soon” requirements and limitations to be overridden based on the pharmacists professional judgement. When in a State of Emergency, system edits continue to trigger; however, the pharmacist is given the opportunity to override the edit by using a unique procedure, dependent on the client’s pharmacy benefits plan configuration and PBM being used. If the pharmacist is unable to process the override, the PBM help desk can assist (which also appears on the back of the member’s ID card). A pharmacist may refuse to accommodate an override request based on their professional judgement.

2) With many medications made in China, will there be a drug shortage in the U.S.?

The U.S. Food and Drug Administration (FDA) has been in touch with more than 180 drug manufacturers to remind them of applicable legal requirements for notifying the FDA of any anticipated supply disruptions and to request that they evaluate their entire supply chain, including active pharmaceutical ingredients and other components manufactured in China.

As part of its efforts, the FDA identified about 20 non-critical drugs which solely source their active pharmaceutical ingredients or finished drug products from China. The FDA has been in contact with those firms to assess whether they face any drug shortage risks, and none of these firms have reported any shortage to date. The FDA is not aware of any cellular or gene therapies that are made in China for the U.S. market, and there are no shortages of biologics to report currently.

Several drugmakers report that they have several months’ supply of pharmaceutical ingredients, however, some have acknowledged that if the situation persists, they may encounter trouble. Because COVID-19 is a novel virus, it is hard to predict how the situation will evolve further as the virus spreads beyond the containment phase. The FDA will remain in contact with manufacturers so that they can continue to assist them with any potential issues.

3) Will plan members be able to access their medications if they are in quarantine?

Members in quarantine will have access to medications through multiple channels, including inpatient and mail-order pharmacies. There should not be any restriction on medication access because of a quarantine situation.

4) Does the PBM Mail Service Pharmacy have an adequate supply of potential COVID-19 therapies, like chloroquine and hydroxychloroquine?

The PBMs have been monitoring the supply of potential therapies for the past few weeks, and along with wholesalers and other pharmacies, have been acquiring additional inventory on these products given the increased demand.

Many of these are products are usually dispensed in acute care settings and retail pharmacies. There are some products that are indicated as a maintenance therapy, such as hydroxychloroquine, and they have seen increased use of those products in their Home Delivery pharmacies. Their pharmacists are monitoring these prescriptions to ensure appropriate use and compliance with emerging regulatory rules across several states mandating quantity limits for these therapies.

COVID-related therapies will be reviewed for new and renewed prescriptions without a diagnosis code to support their valid use, and will be subject to day supply limitations of the medications. Pharmacists will be performing a utilization review for all new and renewed prescriptions to ensure clinically-appropriate dispensing practices.

5) How does the PBM recommend managing the use of potential COVID-19 therapies?

We are seeing a surge in demand for these potential therapies. The PBMs are talking with manufacturers regularly about production, and their clinical teams are determining the appropriate quantity limits based on the limited available clinical evidence for these drugs and COVID-19.

The PBMs also built an anti-stockpiling quantity limitation to ensure appropriate access and protect supply for members who currently rely on these therapies for their approved indications.

6) Are the PBMs concerned about stockpiling of potential COVID-19 therapies?

Across the board, the PBMs are implementing efforts to limit the stockpiling of COVID-19 therapies. Please refer to the PBM-specific pages (CVS Caremark, Express Scripts, and OptumRx) to see how each PBM is managing the situation.

COVID-related therapies will be reviewed for new and renewed prescriptions without a diagnosis code to support their valid use, and will be subject to day supply limitations of the medications. Pharmacists will be performing a utilization review for all new and renewed prescriptions to ensure clinically-appropriate dispensing practices.

Refills of existing prescriptions for these therapies will not be affected by anti-stockpiling quantity limitations.

7) How will the PBM communicate coverage policy updates for potential COVID-19 therapies?

RxBenefits will be informing clients of each PBM’s approach as it is solidified in the coming days.  Likely it will be an automatic update with no potential to immediately opt-out.  No member communications are contemplated.  These guideline changes will occur as part of professional practice as often occurs within utilization review.

8) Are we covering off-label use of potential treatments related to COVID-19?

There is currently no proven treatment for COVID-19, but you may see off-label use of certain medications. For each drug, the PBMs are assessing the published and anecdotal information. If there is enough information to justify, the PBMs will add to their coverage policies and we will communicate updates as we know more. If there isn’t enough data, the PBMs have an escalation process to their medical directors when the prescribing physician specifies that the intended use is the treatment or prevention of COVID-19 and a policy already exists (e.g., Actemra and Kevzara). This escalation process will determine if coverage is appropriate for each patient.

9) The American College of Allergy, Asthma, and Immunology announced that certain areas of the country are experiencing shortages of albuterol inhalers. What does that mean?
The shortage will probably spread throughout the U.S., although it is not a production problem.  The shortage is occurring because of the increased use of albuterol inhalers in hospitals for COVID-19 and suspected COVID-19 patients to help with respiratory issues.

  • There is a concern that nebulizers used on patients with COVID-19 in the hospital could spread the virus in the air. But the possible risk is to hospitalized patients with COVID-19 – not to patients using their nebulizer at home as directed.
  • If a patient has been diagnosed with COVID-19 or suspect that he or she may have COVID-19 and are using a nebulizer at home, the virus may persist in droplets in the air for 1-2 hours. Therefore, nebulized albuterol should be administered in a location that minimizes exposure to household members who aren’t infected.
    • Administer nebulized treatment in locations where air is not recirculated into the home such as a porch, patio, or garage. Choose areas where surfaces can be cleaned more easily or may not need cleaning.
  • If patients and/or caregivers are experiencing trouble obtaining an albuterol inhaler from a pharmacy, the American College of Allergy, Asthma and Immunology offers some practical advice such as checking if the inhaler still has medicine and contacting an allergist or healthcare provider for alternative therapies.
  • The PBMs are actively monitoring drug shortages that may be related to COVID-19, evaluating the impact these shortages may have on members, and will communicate updates, like a recent announcement to employ quantity limits across all plans to curtail stockpiling and supporting appropriate use.

10) Can controlled substances be delivered at this time?

As of April 3, 2020, select states can deliver Controlled Substances (CII – CV) with no signature or ID requirements. Additional states will be added where state Boards of Pharmacy (BOPs) deem eligibility during the COVID-19 crisis. Some drugs of concern are still currently excluded (ex: naloxone, PSE).

Current states: Alabama, Alaska, Arizona, Arkansas, Colorado, District of Columbia, Georgia, Idaho, Illinois, Iowa, Kansas, Maryland, Massachusetts, Missouri, Montana, New Hampshire, New Jersey, New Mexico. Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, and Washington.

11) In an effort to expand testing capabilities, the Office of the Assistant Secretary for Health (OASH) issued new guidance authorizing licensed pharmacists to order and administer COVID-19 tests to their patients. Does that mean the tests will be covered by the pharmacy benefit?

No. On April 8, 2020, the OASH issued new guidance related to testing for COVID-19, but there is currently no NDC or mechanism to bill the testing through the pharmacy benefit, and therefore the administration of the test must be billed through the medical benefit.