The devastating images of the flooding in Texas wrought by Hurricane Harvey have left an indelible mark on the entire country. Several regions in Texas are still underwater, with thousands of people left homeless. Experts project Harvey to be the costliest natural disaster in US history, at an estimate of $160 billion.
 
With travel at a standstill, patients and pharmacists were faced with a difficult challenge in ensuring access to vital prescription medications. In an exclusive interview with Specialty Pharmacy Times, Carmine DeNardo, RPh, president and CEO of ReCept Pharmacy—which has 8 locations in Texas, including Houston and Corpus Cristi—discussed preparing for Hurricane Harvey, how to best assist patients on specialty medications during natural disasters, and moving forward after the floodwater recedes.
 
 
SPT: What kind of preparations were made before Hurricane Harvey hit?
 
DeNardo: [We relied on] our standard operating procedure around disaster and emergency preparedness––which all our employees, pharmacists, technicians, and ambulatory people within the company have to take on an annual basis. We have four basic areas that we do in disaster and emergency preparedness: patient outreach, security, medication storage and availability, and then emergency services.
 
When we know we're going to get a storm, what we try to do ahead of time is prepare our patients by reaching out to them and letting them know we're getting a storm, or getting a hurricane, tornado, or whatever natural disaster or any disaster. We try to reach out ahead of time to get them their medications, deliver their medications, pick up their medications. We [also] reach out to get approvals to fill their medications early, so that we can ship it out to them. That way, if they’re leaving the area or if they’re homebound because they can't get out, they have medication. We prepare our patients way in advance. We started calling on Tuesday, and as it intensified, we started calling our patients ahead of time. We started shipping their medications, coordinating efforts between courier deliveries, and picking them up at our pharmacies [or] neighboring pharmacies––whatever we needed to do to get them their medication.
 
That’s phase 1: making sure our patients are serviced. Second, we need to secure our store so when the disaster is over we can open as quickly as possible without damage––making sure we can get in there and start working as best we can. The other thing is emergency services. Inevitably we get calls, all our phone systems got rerouted to an offsite location so we can answer phones and service any troubleshooting issues that we possibly can. But our emergency services are even beyond that, our pharmacists and our technicians are available to answer any questions. And coordinating our efforts to the next phase, which is business continuity.
 
Eventually, the storm is ended and then what happens? You've got to deal with the aftermath. Patients are homeless, which a lot of ours are right now. Starting to get out of the storm phase, we're headed into the business continuity piece. A patient’s calling us up, “I don't have any medication, where do I get it?” So, working it to one of our other stores, sister stores, going through understanding what their needs are how do we get their medication. At the end of the day, we may open our store tonight––it's a miracle––to start taking care of patients that are in need, start servicing patients that can get to our stores, and we can courier out, skirting around any kind of flooding. But that’s going to be touch-and-go. We’re trying to do our best, we’re really trying to get those patients their medications, that is our primary goal. But you're dealing with patients that don't have homes, some of them are homeless now. So, we’re coordinating, even if we need to deliver it to a shelter or hospital or wherever they can get their meds.
 
SPT: Have any of ReCept’s locations seen an influx of patients due to the storm? Are any of them new patients?
 
DeNardo: Our Fort Worth and Dallas location, we are getting some of our patients, we are able to ship from. But our San Antonio store is doing a lot of work. For whatever reason, we’re getting more patients out of Austin, San Antonio location. What is actually happening, because they know that we're available, is they’re utilizing our services in San Antonio, but it's mostly our existing patients because we are triaging calls into central location and we are servicing out of our local store and courier it to them. Or if they happen to be in the outskirts, which a lot of them are because I think they took refugees in neighboring towns, they're able to get them their medications.
 
SPT: How should patients who take specialty medications prepare for natural disasters, especially those who cannot miss a dose such as transplant patients?
 
DeNardo: We started calling 3 or 4 days in advance in preparing for this, and in some cases patients said, “No, I think I have enough [medication]. I’m going to be okay next week.” But we encourage them … because the city is literally shut down. The medication has been given to them early enough so that they were ready, and we got overrides to be able to fill the prescriptions, you know 5, 6, 7 days earlier so that we were able to get them their medication.
 
I’ve got to give a lot of credit to all our employees staying over, getting prescriptions to their patients in time, so that when the hurricane hit, the vast majority of our patients were in pretty good shape. More importantly, even when patients said, “I’m okay,” we discussed it with [them further] to make sure they were really okay, and that really helped out the situation as well.
 
It’s important that patients really adhere to our pharmacists and our pharmacy teams––who have done a great job in coordinating all their prescription needs ahead of time––because they can't miss doses. Whether it's an HIV patient, hepatitis patient, transplant patient, they always need to make sure their dosing is correct and stay on the regimen.
 
SPT: What safeguards needed to be put in place in case of extended loss of power for temperature controlled medications?
 
AmerisourceBergen is our wholesaler for our temperature refrigerated medications. They're a multi-billion-dollar warehouse with backup generators that store the medication. We wouldn't store it off site with just any generator, because somebody is going to need to monitor it, but this is a pretty big warehouse of distribution medication. So, everything has turned out to be pretty fine.
 
SPT: Could you walk me through how you track down patients who have lost their homes?
 
DeNardo: It's a different day and age these days. Texting and social media are how we are tracking patients down to (1) find out if they’re okay, and (2) do they need anything. More often than not because of our preparedness, we're finding that they're okay and are wondering if we’re okay because we have that relationship with our patients. We are even contacting our physicians and nurses to make sure they're okay. So, there has been a community, back-and-forth, making sure each other is okay and what we can do to help.
 
That’s how we've been in constant communication, and the network has been unbelievable with the group texting and group social media discussions to find out if anybody needs anything. If a medication is needed, we’re coordinating to get the medication, whether it’s courier or they’re in a hospital situation and we’re coordinating with their nursing staff to say, “these are their medications they are on, this is their dosing.”
 
SPT: How has ReCept gone the extra mile to help patients during the hurricane?
 
DeNardo: Being in the health care industry, most of our spouses are somewhat connected. We have one individual within our organization, her husband was out for two days trying to mobilize people in need with his vehicle. He is a first responder and he's out there trying to help, making sure they're okay, bringing them to safety. He’s in the food industry too, that’s his other job, so seeing if he can bring food to people as well. There is a lot of that. Most of our pharmacists’ spouses are in some capacity either nursing, firefighters, or first responder units trying to help patients in need, and not even just our patients, people in need.
 
SPT: Once the flooding recedes, how does ReCept plan to move forward?
 
DeNardo: That’s part of our business continuity, is getting back in our stores and assessing what needs to be happening; calling our patients to see what's needed for them to get their medication.
 
What it really comes down to locating our patients. I mean it'd be great if they're home, but I think more often than not, a great amount of our patients will be displaced until they can get back into their home, if ever. We’re coordinating their care wherever they reside, whether it's something locally, one of our other stores, or shipping them whatever they need in order to stay on therapy.
 
This is not even about our business, it's really about patient care. Making sure they get their medications, whether it's a ReCept store or any other pharmacy that we can partner with to be able to get them their meds until they can get back to their normal life.
 
 I want to reiterate that it’s so great to see a city of almost one million people come together and help each other out. It makes me proud that we have several stores within the city and we’re all banding together to help each other get out of this very bad situation. I’m very proud of everybody, and what we're all doing to make it work as best as we can