New Push to Expand Emergency Access to Lifesaving Medicines

Lilo H. Stainton | October 18, 2018 | Health Care
Diabetic’s near-death experience helps make case for allowing pharmacies to dispense a month’s worth of meds, even without valid prescription

When an expired prescription prevented Jordan Reinhart from getting the insulin he needed at a Woodbridge drugstore one Sunday morning earlier this month, he went home empty-handed. The next morning, the 27-year-old was admitted to intensive care with a potentially life-threatening complication.

That’s the type of situation New Jersey lawmakers hope to prevent with legislation that would permit pharmacists to dispense up to a month’s worth of certain lifesaving medications to regular patients, even if they don’t have a valid prescription. The measure echoes a bill that has passed in more than a dozen other states, according to Jordan’s mother, Debra Reinhart.

The Garden State proposal calls for pharmacists to use their professional judgment before providing the emergency ration and requires them to try and contact the patient’s doctor; it also limits patients to one such exemption per year. The bill covers “chronic maintenance drugs” like insulin and allergy medications, although they are not defined in the bill. It does not apply to opioids or other “controlled dangerous substances.”

Bill sails through committee

The measure, sponsored by Sen. Anthony R. Bucco (R-Morris), cleared the Senate Health, Human Services and Senior Citizens Committee Monday with unanimous support. A companion bill, sponsored by the Senator’s son, Assemblyman Anthony M. Bucco (also R-Morris), awaits a hearing.

“Quality healthcare should never allow for extreme suffering or interruptions in treatment,” Sen. Bucco said. “Patients deserve to have a safe and legal way to refill their medication in emergency situations. No one should be denied access to lifesaving drugs just because they forgot to refill a prescription.”

Under current law, pharmacists are allowed to provide patients with 72 hours’ worth of certain medications, Bucco said. But that provision apparently failed to protect Jordan Reinhart, a Type 1 diabetic, who ended up at JFK Medical Center in Edison with diabetic ketoacidosis, a condition that can occur when the body has too little insulin, and can result in death.

Endangered by the law

Debra Reinhart, Jordan’s mother, told the Senate committee that her son normally gets his insulin through a penlike device that holds enough for six days, but pharmacists declined to furnish him with the pen since this delivery device — which comes in a five-pack — would have lasted longer than the 72-hour maximum allowed in the current law. Other options were available too, Reinhart said, including drawing three days’ worth of the medicine from a vial and selling it separately.

“But they offered him nothing,” Debra Reinhart said Monday. “They let him go home, knowing he had absolutely no insulin.”

“They said there was nothing they could do,” she told lawmakers, adding, “It’s inexcusable not to give out medicine to a known diabetic and let him leave without it.”

Later, Reinhart told NJ Spotlight, the pharmacist “shrugged her shoulders and said, ‘sorry, there’s nothing I can do.’”

Luckily, Jordan Reinhart lives with his girlfriend, who called Debra the next morning when Jordan became ill, with violent nausea and other symptoms. By the time his brother arrived, Jordan was barely conscious, Debra Reinhart said. He needed IV fluids and other treatments once in hospital, where he was admitted to the intensive care unit, but released 24 hours later when his blood levels were stable again, she said.

A fatal mistake

But Kevin Houdeshells was not so lucky. The Ohio man died alone at home in 2014 when he was unable to get the insulin he needed at a drugstore — the result of a New Year’s holiday, according to one report — and after mistaking diabetic ketoacidosis symptoms as stomach flu. Debra Reinhart said the man’s parents have rallied state legislatures across the nation to ease access to emergency prescriptions, like the insulin her son must take several times a day.

While it was not immediately clear if Bucco’s bill was affected by Houdeshell’s advocacy — the New Jersey proposal (S-1135) dates back to 2016 — the goal appears similar: to give pharmacists more latitude in filling prescriptions in what could be an emergency. The New Jersey Pharmacists Association, the state’s Independent Pharmacy Alliance, and CVS Health all supported Bucco’s plan, but did not testify at the hearing.

“By easing access to emergency medications, we can ensure that no mother ever has to go through the fear of losing her child like that ever again,” Sen. Bucco said.

The measure would allow — but not require — drugstores to sell up to 30 days’ worth of meds to a patient without a valid prescription, if that person has filled the same prescription at that store in the past. (If the drug is packaged in a way that provides more than a month’s worth of coverage, the store can dispense a single unit.)

However, if the patient had obtained these drugs through the same emergency procedure in the past 12 months, they would not be eligible for the workaround.

In addition, the bill requires the pharmacist involved to render a professional opinion and to provide the medicine if, in their judgment, withholding the drug would endanger the patient’s health or welfare. And it forces the drugstore to first try and reach the prescribing doctor, or another medical professional responsible for the patient’s care, before dispensing the emergency supply.

The proposal, which was first introduced in March 2016 but did not get a hearing in the previous two-year legislative session, also protects the pharmacist and his or her employer from civil liability for problems with the dispensing process, unless these issues are significant or done on purpose.