Tamiflu in short supply, pharmacists compound doses for children suffering from the H1N1 flu virus

Community pharmacists have stepped up to meet the shortage of Tamiflu by compounding doses for children suffering from the H1N1 flu virus, but they are struggling with supply problems and insurance plans, according to the National Community Pharmacists Association.

Tamiflu’s manufacturer, Roche, asked pharmacists to compound the medicine until supplies improve. The time-intensive process involves extracting powder from capsules, calculating the quantity of medicine, and mixing the right amount with liquid, such as cherry syrup, to produce a suspension with the appropriate prescribed strength for young children.

Over a recent 48-hour period, 80 community pharmacists from around the country told NCPA about their experiences compounding Tamiflu. Nearly half (48%) reported preparing 25 or more suspension compounds since Sept. 1. Virtually all (97%) experienced difficulty in obtaining commercial Tamiflu suspension and many (48%) said the same about Tamiflu capsules, consistent with a front-page story in The Washington Post.

Most prescription coverage is administered by pharmacy benefit managers (PBMs) and 61% of pharmacists surveyed had difficulty adjudicating claims with them for compounded Tamiflu. Most commonly mentioned were the big three – CVS Caremark, Express Scripts, Inc. and Medco Health Solutions, Inc. – but nearly every PBM was identified as a source of difficulty.

Experts advise starting antiviral treatment as quickly as possible. But one pharmacist said, “We had several children that are ‘covered’ by the federal employee [health benefits] program [administered by CVS Caremark] and were told that this compound requires prior authorization which can take from 24 to 72 hours to obtain.”

“Compounding has long been a specialty of independent community pharmacists, and they’re working overtime against H1N1,” said NCPA Executive Vice President and CEO Bruce T. Roberts, RPh. “They’ve helped countless children and won the gratitude of just as many parents.”

“Unfortunately, this is harder than it should be,” Roberts added. “We hope insurance plans and PBMs will reexamine their claims processes to ensure kids get relief as quickly as possible.”