Beth Waldron, MA writes….For patients on life-saving therapies like blood thinners (anticoagulants) having several weeks supply of medication on hand during the coronavirus outbreak is important not only to reduce the need to be out in public, but to ensure you have everything you need already at home if you do get sick.
However, getting an advance supply isn’t always easy. Insurance companies often have rigid schedules for authorizing refills. For example, if you have a 30-day supply prescription, typically one cannot get a refill until day 24 and with some insurers it is as late as day 27. With the coronavirus outbreak, many insurers are under increasing pressure to relax these requirements. Check with your insurance provider to see if they have altered their refill rules in response to the coronavirus.
Ask your doctor for a 90-day prescription of your long-term blood thinning medication.
If you are on a blood thinner long-term and your prescription was written as a 30-day supply, ask your doctor about changing it to be a 90-day supply instead. Most insurance allows for a 90-day refill on long-term maintenance medications. You will still be subject to your insurance provider’s refill rules (typically such as not being able to refill until day 85 or 88), but you will have a greater initial supply in reserve to be able to stay home during this critical ‘flatten the curve’ response time.
Many blood thinners are also expensive, making it financially impractical for some (both with and without insurance) to keep an extra supply of medication on hand. If you are unable to keep a longer supply of medication on hand, do not worry. Be assured that there are no current shortages of blood thinning medication. (more on this below). Having extra medication on hand is recommended simply to help limit the times you will need to leave home (which lowers coronavirus exposure risk), rather than due to any expected drug shortages.
How much medication to have on hand?
The answer is unclear. The Department of Homeland Security recommends having a “continuous supply” of medication on hand. The Centers for Disease Control and Prevention (CDC) suggests keeping an “emergency supply” of mediation. The Assistant Secretary for Health at the U.S. Department of Health and Human Services, discourages excessive stockpiling of medications but recommends having a “healthy supply in reserve”. Some public health experts have tried to put a more precise time on these vague recommendations, by suggesting anywhere from a 1-month to a 3-month supply.
–> Have enough medication on hand so you can stay out of the doctor’s office and pharmacy.
–> Use home delivery or pharmacy drive-thru windows.
–> Take advantage of tele-medicine (telephone, online) visits offered by your doctor.
Without clear consistent guidance, your goal should be to have enough medication on hand so you can stay out of the doctor’s office and pharmacy as much as possible. If your pharmacy has a drive-thru window, use that to limit going inside. Many insurance plans offer home-delivery, so check with yours. Local pharmacies are also beginning to offer home-delivery in response to the coronavirus. Call your pharmacy for options.
Are drug shortages expected?
Prescription drugs have a complex supply chain. While a drug made be manufactured in one country, input ingredients may come from several others. Unfortunately, no one knows exactly which drugs might be subject to shortages, not even the Food and Drug Administration (FDA). The factory which makes a drug and the list of raw materials used and where they come from are all considered trade secrets. The FDA only learns of a drug shortage when notified by the manufacturer after the fact, making it nearly impossible to predict which drugs will come into short supply in the future.
The FDA indicates there are no current drug shortages among the major oral anticoagulant brands. (March 29, 2020)
There is also no legal requirement for a drug company to notify doctors, pharmacies or patients about drug shortages. However, the major oral blood thinner makers indicate no shortage is expected.
- Eliquis (apixaban) Bristol Myers Squib (BMS), in partnership with Pfizer, provides the blood thinning drug Eliquis (apixaban) to the US market. BMS says “we do not anticipate disruptions to the supply of our medicines”.
- Xarelto (rivaroxaban) Johnson & Johnson, parent company of Janssen which makes Xarelto (rivaroxaban), said this week also they have “robust business continuity plans in place across our global supply chain network to prepare for unforeseen events and to meet the needs of the patients.”
- Pradaxa (dabigatran) Boehringer Ingleheim, the maker of Pradaxa (dabigatran) says “Our supply chain and production continue to operate according to plan and we do not foresee short-term issues due to COVID-19 that we cannot work around.”
- Coumadin (warfarin) Bristol Myers Squibb also makes brand name blood thinner Coumadin. They are not anticipating supply disruptions at this time. Generic Coumadin, warfarin, is manufactured by several companies, with heavy emphasis on plants in China and India. No shortages are currently known.
Home injection blood thinners: No shortages are currently reported among the injectible blood thinners Lovenox (enoxaparin) or Arixtra (fondaparinux).
Inpatient blood thinners: What you may read about in the news are shortages of injected and IV blood thinners used in hospitals. Heparin (Heparin Sodium and Sodium Chloride 0.9% Injection) is listed among the FDA’s current shortages. According to the medical journal The Lancet, Heparin was in short supply even before the coronavirus, due to an outbreak of African swine fever in China, where 80% of the world’s heparin supply is manufactured. However, this is a shortage impacting hospitals and does not impact the supply of oral blood thinners.
If there is a shortage, what then?
While there are no current national shortages of oral blood thinners, I’ve heard from patients who have reported pharmacists providing partial-fills of prescription blood thinners due to transport supply disruptions. This localized shortage occurs when people in one area suddenly begin to stockpile medication and the local pharmacy does not have adequate supply on their shelves to meet the unexpected demand. Such shortages are usually resolved fairly quickly in a matter of days, although it can be stressing to only receive a partial amount of a necessary prescription.
Your pharmacist and doctor are both there to work with you to ensure you get the medication you need.
While widespread shortages are unlikely, if you do experience significant difficulty filling your prescription, don’t panic. Know that there are multiple blood thinner options now available. Ask your pharmacist to contact your doctor about an alternative. Reach out to your doctor who can work with you to find a suitable alternative medication. Your pharmacist and doctor are both there to work with you to ensure you get the medication you need.
In response to a shortage, do not be tempted to skip doses, cut pills in half or suddenly stop taking your medication to ‘save some for later’. It is important to continue to take your medication exactly as your doctor prescribed. Again, if you encounter significant supply issues, talk to your pharmacist and doctor who will work with you to find the best possible workaround to your situation.
Be prepared and have a supply on hand so you don’t run out, but don’t hoard medication because the next person who tries to go get their medication may not then have access to it.
Clot Connect 