With the current coronavirus disease 2019 (COVID-19) pandemic, it is not surprising that the impact seen in the pharmacy industry is going to be long-lasting. The initial waves of change that were felt in the beginning of 2020 are sure to be accompanied by a ripple effect when things begin to normalize.

This is strictly speaking for the United States of course, as other regions of the world not previously affected are now seeing substantial rises in cases. Whether it be delivery options, remote pharmacy, increasing roles for pharmacists and technicians, or the increase (and then sudden decrease) in the volume of patients, the impact of this virus can be felt in community pharmacies all across the United States.

SHORT-TERM IMPACTS
Panic
One of the first things seen across the United States in areas in which cases were rising was undoubtedly panic. This panic that the virus was now in one’s hometown caused many pharmacies to run out of items such as hand sanitizer, surgical masks, and gloves.

The panic also caused a potential shortage of OTC items that could be used to treat symptoms of the virus, such as cough and fever.1 The initial waves of COVID-19 resulted in many pharmacies being wiped clean of items such as thermometers, disinfectants, and toilet paper. The shortage of these types of items in a community can have significant impacts on public health.

Increased Patient Volume
The days following initial outbreaks can be accompanied by patients trying to get longer fills on their medications (such as 90-day fills) as people want to reduce as much exposure to the virus as possible. Doing so causes many community pharmacies to experience a high volume of work than normal due to insurance calls, overrides, and filling more prescriptions than usual. As such, the importance of pharmacy technicians has been amplified due to the residual effect of the pandemic.

Decreased Patient Volume
The wave of increased patient volume is at times then followed by a decrease, as many of the patients taking chronic medications request overrides for longer fills and pick up as many medications as possible in case they are needed, leaving longer periods of time between them having to return to the pharmacy.

This decrease in patient volume can lead to community pharmacies to reduce working hours as not as many prescriptions are being filled.

Delivery Services
In order to limit contact between patients, many community pharmacies have taken the CDC’s recommendations on implementing curbside pickup, home delivery, and drive-through pick up.2 Community pharmacies are providing free delivery services to some, if not all, patients. Those pharmacies with drive-through options are experiencing higher volumes when it comes to their drive-through windows.

Laws
Some states are incorporating laws to temporarily allow early refills for controlled medications or to do a 1-time 90-day emergency refill on controlled substances.Other changes in laws include granting temporary pharmacy licenses to out-of-state pharmacists for practice. Florida is one such state that is allowing this.3 In Maryland, pharmacists are able to compound and sell hand sanitizer OTC.3  

In Nebraska, there have been quantity limits and diagnosis codes required for the dispensing of hydroxychloroquine and chloroquine.3 These are just some examples of short-term changes in law that have been brought about by COVID-19.

LONG-TERM IMPACTS
With the COVID-19 pandemic still evolving in the United States, it is hard to say for certain exactly what long-term impacts we are going to see from the remnants of this virus.

Vaccinations
Multiple drug companies are racing to develop a vaccine to combat COVID-19 with clinical trials already under way. Since these clinical trials take time to complete, it has been predicted that there will not be a fully developed vaccine until late 2020 or the beginning of 2021.

This vaccine, if available to community pharmacies, will likely have an impact similar to the Shingrix vaccine, with shortages and waiting lists, as there will be a large demand for it. Initial shipments of a potential COVID vaccine will likely run out quickly and there will be long queues of patients at pharmacies waiting to receive it, similar to what is seen in community pharmacies during flu season.

Stockpiling Medications
Since we are not certain when this pandemic will end, it may be safe to assume that there will be a significant number of patients requesting the largest quantity of medications they can receive in case things take a turn for the worst. With the pandemic still evolving in different parts of the world, it is possible that countries that manufacture medications could be hard hit with the virus causing a disruption in the drug supply chain.4

This could lead to an entirely separate health care crisis from COVID-19 if patients are unable to receive their medications.

EDUCATION
Pharmacists are the most accessible health care providers and as such, it is important to give correct, up-to-date information to patients when being asked questions about the virus. With so much information about the virus in the media, new studies being published, and older information being retracted, it is important that pharmacists stay on top of the developments of COVID-19 research in order to educate the public properly. 

When the COVID-19 pandemic does eventually die out, we can be assured that there will be many lessons to be learned from this all. However, as the rest of this pandemic unfolds, it is certain that pharmacists and technicians will have to undergo more training to be better equipped to handle something like this if it happens again.
Education may very well be the longest lasting impact of the COVID-19 pandemic.

About the Authors
Shivangi Patel is a PharmD candidate at Shenandoah University’s Bernard J. Dunn School of Pharmacy, anticipated to graduate in spring 2021.
Jonathan Ogurchak, PharmD, CSPis the founder and CEO of STACK, a pharmacy compliance management software, and serves as preceptor for a virtual Advanced Pharmacy Practice Experiential Rotation for specialty pharmacy, during which this article was composed.

REFERENCES
  1. Gong Z., Hu T., Liu S.,  et al. Providing Pharmacy Services During The Coronavirus Pandemic. Int J Clin Pharm. 2020;42: 299-304.
  2. N/A. Guidance for Pharmacists and Pharmacy Technicians in Community Pharmacies during the COVID-19 Response. https://www.cdc.gov/coronavirus/2019-ncov/hcp/pharmacies.html?fbclid=IwAR3iN830jGJl9nL4ZC_3-6oYqtfBb_uJGkaQK1bzupq-sMnFluKJnIkTACI. Written: 28 March 2020. Accessed: 12 June 2020.
  3. N/A. COVID-19: Information from the States. https://naspa.us/resource/covid-19-information-from-the-states/. Written: 09 June 2020. Accessed: 15 June 2020.
  4. Hedima EW, Adeyemi MS, Ikunaiye NY. Community Pharmacists: On the Frontline of Health Service Against COVID-19 in LMICs. RSAP. 2020; doi:10.1016/j.sapharm.2020.04.013.