Atlanta, GA—Pharmacists who have experienced natural disasters understand the problem of inaccessible prescription drugs, even when the damage is limited. Imagine how much more critical the need becomes after far larger event, such as when Hurricane Maria made landfall in Puerto Rico as a Category 4 hurricane last fall.

A recent review from the CDC looked at methods to assist in responding to issues of limited or inaccessible prescription medications after disasters such as hurricanes.

The article in the Morbidity & Mortality Weekly Report provides some historical perspective, noting that after Hurricane Ivan made landfall near Mobile, Alabama, in 2004, an assessment of pharmacies in the affected areas found that 53% had depleted supplies and at least 26% had to prioritize distribution to patients because of limited supplies. A year later, a study of Hurricane Katrina evacuees in San Antonio, Texas, determined that medical-assistance teams were more prepared to provide for acute rather than chronic illnesses, yet more than two-thirds (68%) of patients were seeking drugs to treat chronic conditions.

“Understanding the prescribing practices of a region can inform post-disaster medication needs and planning for future emergencies,” CDC authors note.

Public-health officials point out that 5 days after Maria hit Puerto Rico, only about 29% of pharmacies reporting to Healthcare Ready, an organization that provides information on access to pharmacies during an emergency, were open.

To better understand what drugs were needed, the CDC summarized data within the IQVIA data source (formerly IMSHealth, QuintilesIMS). The goal was to supply emergency response teams with projections of formulary healthcare needs following Hurricane Maria, according to study authors, who write, “Prescription data can also highlight important chronic disease concerns for a community.”

The IQVIA database, which contains information on drugs dispensed by retail facilities, is usually used to monitor drug use and trends in the marketplace; public-health officials were able to obtain information on the top 200 drugs dispensed by retail facilities in Puerto Rico during June-August 2017.

The researchers then calculated an average of total prescriptions for those 200 drugs for the 3-month period, which proved useful because the top 200 drugs accounted for about 80% of all prescription drugs dispensed in pharmacies.

Drugs were categorized by therapeutic category and administration route (e.g., oral, inhalation, or topical) by a team of clinicians at the CDC. Top categories were found to be cardiovascular drugs, 21%; psychiatric drugs, 12%; and analgesic drugs, 10%. Most common cardiovascular drugs prescribed were angiotensin II receptor antagonists (29%), beta blockers (20%), and ACE inhibitors (18%).

Overall, the most frequently dispensed individual drugs were:
• Thyroid-replacement hormones (230,324 prescriptions dispensed, 5% of total dispensed);
• Gabapentin (144,114 prescriptions dispensed, 3% of total); and
• Metformin (141,734 prescriptions dispensed, 3% of total).
Nearly all of the prescribed drugs—90%—were for oral administration.

“The distribution of pharmaceutical dispensing practices identified using the IQVIA database can provide information for planning both before and after a disaster,” the CDC authors note. “The most frequently prescribed drugs help focus immediate supply measures for response and recovery efforts, supporting a vital public health need.”

The authors point out that some critical drugs aren’t represented in this data set, however, including insulin.

“Although insulin was not a most frequently purchased or prescribed drug, it is a daily need for persons with insulin-dependent diabetes and should be prioritized,” the researchers add. “To have a more complete picture of important drugs that might be needed after a disaster, multiple data sources, including drug sales data to hospitals, clinics, and nursing homes, as well as information provided by third-party claims adjudication data, could be analyzed to inform public health activities and guide collaborations with drug suppliers to respond to and recover from large-scale disasters.”