By: Justin Ceravolo, PharmD, assistant pharmacy manager for Cypress Pharmacy

During the pandemic, health care officials have reported that fewer people are going to the doctor out of concern about contracting COVID-19. Johns Hopkins Community Physicians initially reported a decline in patients by 20 to 30% at the start of the pandemic.

But doctors caution that waiting too long to get help or manage chronic conditions may be more dangerous in the long-term than the coronavirus. Life threatening symptoms like chest pain, shortness of breath, sudden numbness, weakness or confusion should result in a call to 911.

For minor health issues, an often-overlooked source is your pharmacist. Pharmacists are qualified health care professionals who can offer health and well-being guidance and over-the-counter medications for a range of minor illnesses.

As an essential business open throughout the pandemic, pharmacies have followed strict sanitation and social distancing guidelines designed to protect staff and customers, with many offering curbside pickup and delivery.

In addition to being able to talk to your pharmacist for free, here are 10 other ways your pharmacist can help you:

1. They are qualified health care professionals. Pharmacists must pass state and national licensing exams and spend six to eight years in pharmacy school learning about medicinal chemistry, pathophysiology and pharmacotherapy. Pharmacy has a rigorous system of checks and balances and is one of the most regulated professions.
2. They are an important component of medical care. While pharmacists typically can’t diagnose illnesses or prescribe medication, they are frequently readily available without an appointment. The pharmacist’s role isn’t to keep you from seeing your doctor, but can make you more aware of your symptoms and when to seek the appropriate help. Pharmacists are also trained at identifying types of muscle aches, headaches, coughs, rashes, stomach issues and colds and the flu and know which over-the-counter medicines can help as well as what conditions require a doctor’s attention.
3. They are experts in how medications interact with other drugs and conditions (pharmacodynamics), helping to keep you safe when you are taking multiple medications and supplements. Pharmacists can tell you the best, most effective time to take your medications and possible interactions with food and when inactive ingredients in some drugs may be a problem for people with allergies. They know how medications are absorbed and distributed in the body, metabolized and excreted.
4. They can help you save money. Pharmacists can help you find over-the-counter medications that offer the best value for your symptoms. They also know whether there’s a generic equivalent or a therapeutic equivalent medicine that’s equally effective but less expensive.
5. They can administer vaccines. Your pharmacist can bill your health insurance and provide flu shots and other vaccines, including influenza, hepatitis A and A/B, HPV, Measles, mumps and rubella, meningitis, pneumonia, shingles, tetanus and whooping cough.
6. They can offer basic medical tests. Flu and strep tests are available, and if positive, your pharmacist will contact your physician for a prescription. You can get a combined cholesterol and glucose finger stick test with accurate, on-site results in minutes. You can test your blood pressure. You can use a service to order many tests such as diabetes, basic biomarkers and hormone levels to be sent to a nearby lab. Your pharmacist can also help you interpret the results.
7. They can help manage diabetes. In addition to helping find supplies that work best, pharmacists can prevent serious errors by helping you administer insulin, understand its effects and determine when you should and shouldn’t use it. Pharmacists can teach you how to inject insulin and other drugs.
8. They can provide creative ways to take medicine. Are you not a fan of how your medicine tastes? Pharmacists can enhance the taste of medication, while ensuring that the flavor is compatible with the medication’s properties. A compounding pharmacy may be able to compound multiple prescriptions into one dose. They can also prepare another way to deliver medicine, such as topical gels, creams, suppositories or sublingual troches. For example, if a patient has difficulty swallowing, a compounding pharmacist may prepare the drug as a flavored liquid suspension.
9. They can provide lifestyle and well-being advice, as well as medication and insurance education. Pharmacists can provide advice on how to eat healthily and lose weight. They can help with smoking cessation. Some pharmacies have functional medicine counseling, helping to keep people from getting sick in the first place in order to promote optimal health. While pharmacists can help in person, online resources are also available. Pharmacists can help provide pill identification when drugs are separated from packaging, drug disposal and even compare Medicare plans to narrow plan options based on current prescriptions.
10. They can help take care of your pets. Compounding pharmacies can compound pet medications, as well as offer over-the-counter treatment and prescriptions.

The next time you pick up a prescription and are tempted to decline counseling, think about all the things you can talk to your pharmacist about. They are available to help in your journey to wellness and health in partnership with doctors, and are a vital part of the health system.

Recent U.S. Postal Service changes have caused delivery delays for mail-order medications, but this is only one issue that can result from mandatory mail order prescription plans.

For years, Pharmacy Benefit Managers (PBMs) have forced or incentivized patients and employers into mandatory mail-order plans that represent a severe threat to public health and restrict patients’ health care choices.

Locally, some of the area’s largest employers have adopted these mail-order plans, causing employees to involuntarily change pharmacies, sometimes the pharmacy they have trusted for years.

These mail-order plans cause a severe threat to public health in many ways:

1. Improper handling. Anyone who has gone outside during a Florida summer knows the impact of heat and humidity. The ideal storage temperature for most medications is between 68 and 77 degrees. Above that temperature, prescription medications can lose potency or could even decompose to form different compounds, some of which could be harmful.

Brick and mortar pharmacies are required to store their medications properly before dispensing, but mail-order prescriptions can be left in a hot mailbox for hours. The time spent in mail transit, especially with current delays, can expose medication to other harsh conditions.

2. It’s wasteful. One of the arguments used in favor of mail order is that it saves money. However, medications are often automatically shipped to patients even when they don’t want or need them, and sometimes even after a person has passed away. By law, these medications cannot be returned and must be disposed of, leading to expensive waste.

As a pharmacy that offers medication disposal, we see firsthand the waste generated from mail-order pharmacies. We have disposed of hundreds of thousands of dollars’ worth of mail-order waste over the years, and so have our colleagues around the country.

3. Lack of proper counseling and medication management. Mail-order pharmacies offer counseling over the phone, but they cannot recreate the relationship built between a patient and a community pharmacist. Your local pharmacist regularly communicates with your physician and knows you, your medications and your regimen. Most importantly, he or she can spot if something isn’t right. For example, say you go to multiple physicians, and they inadvertently duplicate therapies or, even worse, prescribe something that could cause serious interactions.

Your community pharmacist is familiar with your conditions and medications and can coordinate care with your physicians. That level of care and attention isn’t possible with a mail-order pharmacy.

4. Conflicts of interest. Most patients are steered into mail-order pharmacies owned or affiliated with PBMs, which are often owned or affiliated with health plans. PBMs are responsible for

developing and maintaining the drug formulary, contracting with other pharmacies, negotiating discounts and rebates with drug manufacturers and processing drug claims. Antitrust laws have failed to prevent this unfair competition and predatory practices.

Due to a lack of regulation, formulary drugs are often selected based on the best rebate paid by the manufacturer to the PBM instead of the most effective medication or even the prescription chosen by the patient’s physician. This often means switching medications that a person has been on for years. PBM practices don’t put the needs of the patient first.

5. Loss of patient choice. Some patients prefer mail order, but it should be their choice. Unfortunately, it rarely is a choice. Patients are left to deal with dangerous delays, improper medication handling, and inadequate counseling and medication management.

It is time to rethink whether the mail is the best means to deliver medication. Americans prefer freedom of choice and options in the marketplace, and it is time to bring this back to pharmacies.

By: Justin Ceravolo, PharmD, assistant pharmacy manager for Cypress Pharmacy

Ready or not, the 2020 hurricane season is upon us. We’re already off to a fast start, with forecasters predicting an above-average season and up to nearly two dozen named storms. Although planning for a hurricane may not be top of mind given the current pandemic, it’s more important than ever to prepare now for future storms on the horizon.

The lessons of past hurricane seasons reinforce the importance of anticipating what needs will arise before, during and after the storm. For those managing conditions such as diabetes or heart disease, going without medication can be life-threatening. Therefore, it’s vital that your hurricane readiness plan includes securing all personal medications.

Preparations will likely require extra steps this year, so don’t wait until a storm is only days away. With possible pre- and post-storm scenarios including evacuations and extended closures that may limit access to prescription medications, now is the time to prepare a stockpile of over-the-counter medications and all regular prescriptions.

Consider these steps for preparing your prescription medications before the next storm:

1. Do not wait – fill prescriptions early. Work with your health care provider and pharmacist to order and fill an extra 30-day supply of all medications needed in advance of a storm, and make sure your annual prescription renewals are up to date. According to Florida law, you can obtain a 30-day refill, even if you just refilled your prescription, if you are in a county that is under a hurricane warning, a state of emergency or has activated its emergency operations center. (See floridadisaster.org for prescription refill information)
2. Keep a written and digital backup record of your current prescriptions with you if you evacuate or in a safe, dry place. Ideally, share information with someone out of the storm’s path who will be able to access and share your information after the storm. Keep a record of your current dosage and doctor’s contact information for each medication to help pharmacists assist you during an emergency. Carrying copies of your medical insurance, Medicare and Medicaid is also highly recommended, in case it’s hard to search records when systems or power are out. Proof of residency (such as an electric bill) may be needed to re-establish insurance and other disaster assistance when that time comes.
3. Make sure medication is properly stored. Be prepared in case you lose power for a prolonged period of time by storing medications that require refrigeration in coolers and ice to keep them cold. Insulin, for example, must be refrigerated, and other medications can become unstable in extreme temperatures. Store medication in waterproof bags to protect from water and contamination.

Well before the next predicted storm, check to make sure all over-the-counter medications have not expired. (Why wait for a storm? You should check medications regularly to make sure they are not out of date.)

Recommended medications and supplies to have on hand (and packed should you need to evacuate) include:

• Acetaminophen for fever
• Benadryl and Ibuprofen for pain and inflammation, plus topical products such as hydrocortisone and Benadryl cream
• Miralax or stool softener for constipation
• Imodium or Pepto Bismol for diarrhea and upset stomach
• Band-Aids and bandages for cuts and scrapes
• Wet cleaning cloths (such as baby wipes) in case clean water is unavailable
• Water (five gallons per person to last three to five days) and Pedialyte for hydration
• Soap and alcohol-based hand sanitizer to kill germs
• First aid kit
• Protective face masks, especially if evacuating to a public evacuation shelter

Try to have documentation of your immunization records in case of exposure to unsanitary conditions. Injuries are common during disasters, so patients should know if they are up to date on tetanus vaccines. If available, get your annual influenza vaccine, as it may be difficult to obtain during and after a hurricane.

In addition, establish a network of people including neighbors and friends who know of your medical conditions. This support group can help oversee any care for you in the event of a disaster.

With some advance planning, you and your family can feel better prepared to weather the storm.