Pharmacy Forecast 2020 Provides Recommendations on Dealing with Unpredictable Events

This strategic planning guide features a chapter on black swan events or rare events (widely deemed improbable) with massive consequences. As pharmacists work to combat COVID-19, the importance of having systems in place to respond to unanticipated events has never been more clear.

Pharmacy Forecast authors James M. Hoffman, Pharm.D., M.S., BCPS, FASHP, Scott Knoer, M.S., Pharm.D., FASHP, and William A. Zellmer, B.S.Pharm., M.P.H., recommend that practice leaders take an honest assessment of their departments and encourage their teams to pay attention to major global trends that could evolve into events that affect pharmacy practice. They also suggest that pharmacists use the Pharmacy Forecast annually to help departments shift their focus from near-term operational issues toward long-term strategic issues.

The Pharmacy Forecast 2020 examines developments that may be challenging for practice leaders and provides recomendations on how to prepare for them. The Pharmacy Forecast was supported by a grant from Omnicell, Inc., to the ASHP Foundation's David A. Zilz Leaders for the Future Fund.

ASHP COVID-19 Resource Center

ASHP is committed to supporting you in the response to the COVID-19 pandemic and is regularly communicating updates on this crisis. We have opened access to our evidence-based online resources and tools on ashp.org, making them widely available to all pharmacists and healthcare professionals, and ourCOVID-19 Resource Centeris updated frequently. ASHP has also launched a newCOVID-19 Community on Connect, which serves as a forum for any healthcare providers to ask questions, share experiences, post resources, and more. Thank you for all that you are doing for your patients and your community.

Open Access To ASHP's Interactive Handbook On Injectable Drugs

In response to the rapidly increasing use of parenteral medications needed for the critical care of patients with COVID-19, ASHP is providing free access to theInteractive Handbook on Injectable Drugs.

The Interactive Handbook on Injectable Drugs has monographs for 400 parenteral medications including sedatives, neuromuscular blockers, opioids, and vasopressors. Users can search compatibility results for drugs and solutions under the Compatibility Tab. For additional details, use the Monograph Tab to locate information on:

• Solution concentrations
• Administration
• Compatibility
• Stability
• Extended stability (when available)

Access ASHP's Interactive Handbook on Injectable Drugs.

Additionally, ASHP has also opened access to our evidence-based online drug information tool, AHFS Clinical Drug Information®. AHFS CDI is available with theusername: ahfs@ashp.organdpassword: covid-19.
ASHP's patient medication information is available atwww.safemedication.com.

Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19)
A Review

JAMA | Review - Published online April 13, 2020 [Abstract Below]

ImportanceThe pandemic of coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents an unprecedented challenge to identify effective drugs for prevention and treatment. Given the rapid pace of scientific discovery and clinical data generated by the large number of people rapidly infected by SARS-CoV-2, clinicians need accurate evidence regarding effective medical treatments for this infection.

ObservationsNo proven effective therapies for this virus currently exist. The rapidly expanding knowledge regarding SARS-CoV-2 virology provides a significant number of potential drug targets. The most promising therapy is remdesivir. Remdesivir has potent in vitro activity against SARS-CoV-2, but it is not US Food and Drug Administration approved and currently is being tested in ongoing randomized trials. Oseltamivir has not been shown to have efficacy, and corticosteroids are currently not recommended. Current clinical evidence does not support stopping angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in patients with COVID-19.

Conclusions and RelevanceThe COVID-19 pandemic represents the greatest global public health crisis of this generation and, potentially, since the pandemic influenza outbreak of 1918. The speed and volume of clinical trials launched to investigate potential therapies for COVID-19 highlight both the need and capability to produce high-quality evidence even in the middle of a pandemic. No therapies have been shown effective to date.

FDA Responds to ASHP Request; Provides Compounding Flexibility

In response toASHP's advocacy efforts, tonight, the Food and Drug Administration (FDA) announced clarifications for compounding of drugs in shortage and compounding in hospitals.

Specifically, FDA announced that it will not enforce the one-mile radius requirement from the agency's 2016Hospital and Health System Compounding Draft Guidance. This clarification was not time-limited, and we anticipate that it will remain in effect after the national emergency ends. FDA also clarified which drugs it designates as not "commercially available," meaning that these drugs can be compounded by 503A and 503B pharmacies. FDA further noted that it would not be enforcing the 5% limit on interstate distribution of compounded drugs until after the draft Memorandum of Understanding takes effect.

FDA's clarifications provide flexibility for hospitals and pharmacies to compound products that are desperately needed to care for our patients during the COVID-19 pandemic. ASHP applauds FDA's quick action to reduce regulatory hurdles for health systems to respond to this crisis.

ASHP will continue to advocate for additional compounding flexibility, including the expansion of the definition of "drugs in shortage" to include drugs on ASHP's shortage list. We will also continue to seek 503B outsourcing facility flexibility, particularly for hospital-owned or affiliated 503Bs, to help ensure they can meet hospital medication needs during the COVID-19 crisis.

Chloroquine and Hydroxychloroquine Toxicity and Treatment

Please view and share thisquick reference on chloroquine and hydroxychloroquine released by the Maryland Poison Center via their ToxTidbits. Any questions, comments, or ToxTidbits topic suggestions can be directed toEric Schuetz, BSPharm, CSPI, Coordinator of Professional Education,Maryland Poison Center.

Other Resources

• Summary of the issues with the study on HCQ + Azithro -"How Does Hydroxychloroquine and Azithromycin Combination Therapy Measure Up For COVID-19 Treatment?"

• SIDPCOVID-19 Resources on Experimental Agent Reviews-Members from the Society of Infectious Diseases Pharmacists have prepared brief, evidence-based reviews of potential pharmacotherapeutic treatment options for COVID-19. These video presentations and handouts will be updated regularly as new data emerge on each of these experimental therapies.