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Texas Pandemic Influenza Regional Conference
Antiviral Medication Distribution
Texas Department of State Health Services (DSHS)And
Texas Division of Emergency Management (DEM)
August and September, 2009
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
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
Page 2
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
• 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
Antiviral MedicationWhat Is An Antiviral Medication?
Page 3
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
Treatment
1. Must be used within 48 hours of onset of symptoms for maximum effectiveness
2. 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
3. Healthcare providers should follow guidance from DSHS found at www.texasflu.org
4. Antiviral medications can sometimes be used for preventive treatment in limited situations
Antiviral MedicationBrief Overview of Clinical Guidelines
Page 4
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
Antiviral Medication VaccinePrimarily used to treat influenza, specialized use for preventing influenza
Used to prevent influenza
Does not build immunity in your body Helps your body build its own immunity
You are only protected from influenza while you are taking the medication if used for prevention
Once your body develops immunity, you have lasting protection
Finite amount of medication, not enough to serve everyone
CDC plans to have enough for anyone who wants it
Antiviral MedicationDifferences between Antiviral
Medication and Vaccine
Page 5
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
Q What is the Strategic National Stockpile?
AThe 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
• 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.
Antiviral MedicationStrategic National Stockpile Overview
Page 6
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
QWhat is the State Stockpile?
AA 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
• 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
Antiviral MedicationState Stockpile Overview
Page 7
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
Q When will the State Stockpile Be Used?
AThere 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
Antiviral MedicationState Stockpile Overview
Page 8
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
Healthcare provider
determines if an antiviral is
appropriate
Healthcare provider
determines if an antiviral is
appropriate
Healthcare provider writes
prescription
Healthcare provider writes
prescription
Pharmacist fills prescription
Pharmacist fills prescription
Access to Antiviral Medications for Patients
Ro
utin
e C
ha
nne
l fo
r P
atie
nts
Antiviral Allocation and Distribution
Routine Channels for Access to Medication for Patients
Page 9
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
• 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 patient’s 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
Antiviral Allocation and Distribution
Access to State Stock Medication for Patients
Page 10
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
Healthcare provider determines antiviral
is appropriate
Healthcare provider determines antiviral
is appropriate
Healthcare provider writes prescription
Healthcare provider writes prescription
Health Care Provider refers
patient to a pharmacy that has
state stock
Health Care Provider refers
patient to a pharmacy that has
state stock
Access to State Stock Antiviral Medications for Specific Patients
Healthcare provider identifies state stock
is needed
Healthcare provider identifies state stock
is needed
Pharmacist fills prescription from
state stock
Pharmacist fills prescription from
state stock
Antiviral Allocation and Distribution
Access to State Stock Medication for Patients
Page 11
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
Local Health Departments
1. Local health departments addressing public health outbreak control can access the state stockpile if local supplies are nearing or at depletion.
2. The local health department should contact the health service region to make this request.
Antiviral MedicationPublic Health Measures to Address
Outbreak Control
Page 12
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
Antiviral Allocation and Distribution
Routine Supply Channel for Health Care Entities
Access to Antiviral Medications for Health Care Entities
Medication supply runs
low
Medication supply runs
low
Order from supplier
Order from supplier Treat patientsTreat patients
Ro
utin
e C
ha
nne
l fo
r H
ea
lth C
are
Ent
itie
s
Page 13
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
If routine supply channels break down, the Health Service Region has a mechanism to provide supplies to health care entities.
Access to Antiviral Medications for Health Care Entities
Medication supply runs
low
Medication supply runs
low
Order from supplier
Order from supplier Treat patientsTreat patients
Ro
utin
e C
ha
nne
l fo
r H
ea
lth C
are
Ent
itie
s
Antiviral Allocation and Distribution
Routine Supply Channel for Health Care Entities
Page 14
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
Chain Pharmacies
Independent Pharmacies
FQHCs / CHCs
DSHS
Local Health Departments
Uninsured/ Underinsured Populations
Healthcare Systems
DSHS Health Service Region
Antiviral Allocation and Distribution
Distribution System for State Stock Antiviral Medication
Page 15
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
• 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.
Antiviral MedicationReporting
Page 16
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
Uninsured and UnderinsuredUninsured and Underinsured
Outbreak Control
Outbreak Control
Supply Disruption
Supply Disruption
• 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
• 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
• Used to meet immediate health care entity needs to due to supplier disruption or unavailability
Antiviral MedicationState Stockpile Utilization Summary
Page 17
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
Q
A• DSHS will review epidemiological information at that time
• DSHS will revise treatment guidance if necessary to determine appropriate allocation of the remaining stockpile
What happens if the supply chain is completely unavailable ?
Antiviral MedicationComplete Supply Chain Disruption
Page 18
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org
• 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
Antiviral MedicationKey Points
Page 19
Texas Pandemic Influenza Regional Conferences
Antiviral Medication Distribution www.texasflu.org Page 20
Antiviral MedicationConsiderations
Department of State Health Services
Department of State Health Services
• 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
Local CommunitiesLocal Communities
• 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