Eighteen states have enacted legislation that allows pharmacists to help patients when providers are not reachable.
Expansions of 72-hour emergency supply of medications laws have emerged across the country in recent years. Often called “Kevin’s Law,” it updates how pharmacists can help patients access lifesaving medications in times when providers cannot be reached. How did Kevin’s Law come to be, and what should pharmacists know about it?
In 2013, 36-year-old Kevin Houdeshell died unexpectedly on New Year’s Eve. The cause of death was diabetic ketoacidosis (DKA), a condition in which the body breaks down fat at an alarmingly fast rate. This occurs in response to insufficient insulin levels. The liver then processes the broken-down fat into ketones. Ketone accumulation significantly lowers blood pH, causing a person’s blood to become acidic. Untreated, DKA can put a person into a diabetic coma or even cause death. Common symptoms of DKA are abdominal pain, abnormally frequent urination, confusion, fruity breath, and thirst.
Houdeshell had type 1 diabetes, and his drug regimen included both fast- and long-acting insulin. Four days before his death, he tried to pick up his insulin refills at the local pharmacy. Unfortunately, Houdeshell’s prescriptions had expired. His pharmacist tried reaching the prescriber and directed Houdeshell to do the same. With the medical office closed for the holidays, efforts by both were unsuccessful. It was reported that Houdeshell, working as a bartender, repeatedly called his physician’s office, placing his cell phone on the bar while it rang on speaker phone.1
After the death of their son, Houdeshell’s parents began looking for answers. They knew the prescriptions were expired, but shouldn’t pharmacists be able to help patients access lifesaving
medications in such situations?
Some states, such as Kentucky, have in place a regulation or statute that authorizes a pharmacist to dispense a 72-hour supply of medication when a prescriber cannot be reached.2 But there are limitations. It must be a noncontrolled medication used to treat a chronic condition. The pharmacist must verify that the medication was previously dispensed to the patient and make a reasonable effort to contact the prescriber. Before dispensing, the pharmacist must use professional judgment to decide whether refusal would negatively affect the patient’s health or welfare. The pharmacist must document the emergency dispensing, and just one 72-hour supply may be dispensed per given medication.
However, that rule can come up short of addressing all situations, presenting a patient dilemma. For 72-hour supply emergency dispensing, situations such as Houdeshell’s present a major challenge. Certain medications cannot appropriately or easily be dispensed in 72-hour supplies. To dispense a 72-hour supply of insulin, a pharmacist would likely need to remove and waste a significant amount of the contents from the insulin pen or vial. The same holds true for inhalers and other multidose medication delivery systems. As an example, consider Trelegy Ellipta, a once-daily inhalation used to treat chronic obstructive pulmonary disorder. An unused Trelegy Ellipta contains 30 doses. To dispense a 72-hour supply, a pharmacist would need to manually expel 27 of the doses, an act that would be considered highly impractical, inappropriate, and wasteful.
After learning about the limitations in approaching such situations, Houdeshell’s parents approached their Ohio state senator and asked for his help finding a solution. From there, the initial Kevin’s Law was born. Signed into law in 2015, Kevin’s Law expanded emergency dispensing authorization in Ohio up to a 30-day supply for all noncontrolled medications.2,3
Since 2015, 17 state legislatures have joined Ohio in passing similar bills. Although details of the laws vary from state to state, the underlying effect is the same: an expanded ability for pharmacists to dispense lifesaving medications beyond a 72-hour supply. Like Ohio, many other states have named their emergency fill expansion bills after Houdeshell.
So far, versions of Kevin’s Law exist in Arizona, Arkansas, California, Colorado, Florida, Idaho, Illinois, Indiana, Kentucky, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, West Virginia, and Wisconsin.
Advocacy groups are actively working to have Kevin’s Law on the books in all 50 states.4
The authorization for the pharmacist to act in such situations varies among jurisdictions. Some states limit the authority only to specified medications, such as insulin, while others have expanded coverage to include a variety of medications, such as blood thinners, EpiPens, HIV maintenance medications, hypertension medications, inhalers, and medications for mental health disorders. Some states specify a 72-hour quantity limit, and some limit that action by the pharmacist to once per year per prescription.4
Being up-to-date on emergency fill laws, particularly for the state in which an individual practices, is of the utmost importance for pharmacists. This knowledge allows pharmacists to best serve patients, and, in situations like Houdeshell’s, it can truly mean the difference between life and death.
Scotty Reams, PharmD, is a 2021 PharmD graduate of the University of Kentucky College of Pharmacy in Lexington.
Joseph L. Fink III, JD, BSPharm, DSc (Hon), FAPhA, is a professor of pharmacy law and policy and the Kentucky Pharmacists Association Professor of Leadership at the University of Kentucky College of Pharmacy in Lexington.