When chronic meets crisis

The past few months have brought more questions than answers. When will we go back to work or school? When can I hug my grandkids? How can I keep my family safe?
 
If you’re someone who lives with a chronic condition such as arthritis, autoimmune disease, diabetes, migraines or heart disease, these common questions may be accompanied by more specific concerns. Chronic conditions can affect daily life, not only because of the symptoms they cause but also because of the interventions they require – things like regular physical therapy, specialty medications that have to be refrigerated and treatments given through infusions or injections. And when the world shuts down, so does access to many of the activities, services and resources that help people with chronic conditions thrive.     
 
To help answer some of the concerns raised by these trying times, we invited the Global Healthy Living Foundation, a nonprofit organization whose mission is to improve the quality of life for people living with chronic illnesses, to have their patient community submit questions for our pharmacists. Then we went straight to our expert panel – three Walgreens pharmacists who have a passion for serving patients with chronic conditions.
 
 
The pandemic has caused my doctor’s office to be busy. My prescription needs a prior authorization. I can't get a hold of anybody. What can I do?


 

Sydney L. Beliles, clinic manager, Jacksonville, Fla.

Sydney L. Beliles, clinic manager, Jacksonville, Fla.: Please, please call your local Walgreens pharmacist. And when you do, I highly recommend you ask them if they can connect you to one of our community-based specialty sites close to their area to see if we can help with the insurance issue. My team and I specialize in chronic and complex disease state management, and a big part of our daily activities is helping patients and providers with the prior authorization process. Our reach is not just at a local level; we often are helping patients all over the states in which our pharmacies are located. While we typically handle insurance issues for specialty medications, we can also help with your regular medications, too – like blood pressure or diabetes drugs. That includes working with you, drug manufacturers and foundations to help lower the cost of your medications in the event you can’t afford your copay or out-of-pocket expense.

Don’t ever hesitate to reach out – that’s why we are here.

 
I take several medications due to my chronic illness. I want to go out as infrequently as possible and am worried about having to refill these prescriptions. Any advice?


 

Tyler Liebegott, pharmacy manager, Pittsburgh

Tyler Liebegott, pharmacy manager, Pittsburgh: Many insurers are allowing for COVID-19 overrides, which will allow you to get all of your medications together for a 90-day supply. It is important to speak with your local pharmacist and your insurance company to see what’s possible, but there could be a way to get enough medication for up to three months. In addition, you could take advantage of Walgreens prescription delivery, which can eliminate trips to the pharmacy and decrease your risk of exposure.
 







What if the pandemic causes there to be a shortage on my medication? Will the pharmacy just change to a different manufacturer?

 
Benjamin Beshalske, specialty pharmacy manager, Chicago: At this time, we are only seeing shortages for a limited number of medications. When we do have to change manufacturers, the medications are still from another company that has had FDA approval to make that drug – and we always make sure to inform patients about the change. We also highlight this on the patient leaflet, and patients can always compare the tablet markings on the tablet with what is printed on the prescription vial. If patients have any doubts, we always recommend they call the store and speak to a pharmacist if they have questions.
 
Have you noticed if fewer people are actually coming in to collect their prescriptions during this time? What are some of the things that can be done to address this?
 
Liebegott: As a pharmacy manager, I have noticed a decrease in the traffic within the store, but I have also seen an increase through our pharmacy drive-thru, which is a good way for people to reduce their chance of coronavirus exposure. If you’re concerned about entering the store for non-prescription needs, Walgreens also provides over-the-counter medications and other essentials through the drive-thru at locations that have one, as well as prescription delivery through FedEx.
 
With so much going on with the coronavirus, how are you making sure your patients still have a positive experience?
 
Beshalske: We are trying to maintain social distancing both among our staff and with our patients as much as possible. We are also frequently cleaning the registers, waiting area, PIN-pads, etc., to make customers feel like they are coming in to a clean and safe environment. We are heavily promoting our free delivery so patients don't have to leave their homes, especially our patients with underlying health conditions. When patients call for refills, we always inform them about the delivery option. Being on a hospital campus, we have been working with the hospital staff to make sure patients have all the things they need before discharging from the hospital so they don't have to make additional trips out before heading home.
 
It’s difficult to keep patients updated because information is changing so quickly. I do feel confident in telling patients about the importance of wearing a mask in public, washing their hands and staying at home as much as possible. The difficult part is trying to answer questions from patients about when things will "get back to normal" because I don't think anyone has the answer just yet. Overall, our team is just trying to tailor each interaction with every customer to their needs, with the goal to keep everyone safe and healthy.
 
How has social distancing affected your interaction with patients?

Beliles: My pharmacy is located inside of a cancer center and is a very small, intimate setting designed for close patient interactions. My waiting room is only four chairs.  I also have a separate small room that I typically use for in-depth patient counseling sessions – just big enough for two chairs and my compact desk.
But right now, our pharmacy is protected by Plexiglas barriers to enhance patient and staff safety; we have social-distancing markers on the floors, and my consultation room door is closed and no longer used for counseling patients. My staff and I perform the majority of our services over the phone now instead of face-to-face. While the message and counseling points remain the same, the personal interactions are much different. Where we would typically sit and offer our hands to hold, give comforting hugs and handshakes, meet  patients’ families, give high-fives upon treatment completion or share laughs to help patients get through the tough side effects, we are now a voice on the other end of a phone.
Navigating our new normal has been a change not only for our patients but for me and my staff as well. We didn’t realize how much we would miss seeing patients’ faces and the healing and supportive power of the human touch.

Do you have any advice for those who live with pain caused by chronic conditions during this time?

Liebegott: Chronic pain is something I encounter a lot of as a retail pharmacist, more often than people would think. My heart goes out to those patients right now, because often chronic pain is worsened by stress and anxiety – something we are all feeling at the moment due to the pandemic.
 
Exercise can have one of the most positive impacts on chronic pain patients, especially for muscular and joint pain. Although it is difficult to be as active as you once were, continuing to be active is important. I know this can be challenging with gyms and swimming pools closed right now, but you can always go for a short walk around the neighborhood or find some simple home exercises on the internet.
 
Lastly, when possible, be socially active during this quarantine, even if it’s done virtually or over the phone. Ensure you are staying in touch with loved ones and family, as we can start to feel lonely. You can even socialize with your pharmacist – we are always just a phone call away.