History of Emergency Prescription Fulfillment Policies in the Wake of Hurricanes Harvey and Irma

Sarah Johnson
Associate Editor
Loyola University Chicago School of Law, J.D. 2019


In the midst of a natural disaster people gather their children and pets, try to locate a temporary home, and worry what situation they may come home to. The first things people think to grab have nothing to do with their prescription drugs. However, according to a study performed by the U.S. Department of Health and Human Services, from 2011-2014, 46.9% of the population was prescribed a drug in the last 30 days; prescription drugs are an important factor in many peoples’ lives. When portions of the population are displaced from their homes during a natural disaster, they often forget their pill bottles and/or prescriptions. Thankfully, following Hurricane Katrina, regulations were put in place to help people in these situations.

Prescription preparedness for Hurricane Katrina

Most preparedness websites inform residents that when preparing for a hurricane they should pack a “go-bag” including, amongst other things, any medications and copies of critical information. What happens if someone does not have a physical copy of their prescription, forgets their prescription, or forgets their medication all together, and is evacuated? When Hurricane Katrina hit in 2005 these worries moved to the forefront of many people’s minds. At that time, there was no procedure in place for pharmacies to handle the influx of need due to the storm’s refugees.

Following Hurricane Katrina, emergency departments and local pharmacies in Alabama were inundated with requests for medication refills from these refugees. People were asking for medications as they had forgotten their prescription bottles at home.  Alabama’s 72-hour emergency refill provision allowed pharmacists to provide an emergency amount of non-narcotic medication to any patient that brought in a medication bottle. What happens when there is no medication bottle or the patient is displaced for more than 72 hours?

In Alabama, emergency refill provisions were suspended by the governor in order for displaced patients to receive 30 day’s supply of their emergency, non-narcotic prescriptions. The Alabama pharmacies and emergency departments that had been inundated with this type of problem also came up with a protocol to handle the influx of emergency prescription refills. This protocol, when to give a prescription to a patient without first seeing a doctor, when to send the patient to a physician at triage before refilling the prescription, and which chronic medical conditions needed the 30-day refill as a necessity later influenced pharmacies’ actions around the country. Thanks to their quick thinking, the pharmacists of Jefferson County, Alabama, paired with the local pharmacy school were able to care for all refugees through triage and medication refills.

Government action regarding emergency prescription disbursement post-Hurricane Katrina and Hurricane Rita

Following Hurricane Katrina and Hurricane Rita, which came shortly thereafter, the National Association of Boards of Pharmacy (NABP) realized that a plan needed to be made to aide drug distribution systems in the event of a natural disaster. Resolution Number 102-4-06 was passed on April 15, 2006, resolving that the NABP should “continue its efforts in collaboration with government agencies, national professional associations, and industry representatives in the development of a response to natural and man-made disasters that affect the US drug distribution system,” meaning the NABP agreed that they needed to come up with a policy regarding this problem.

In November of the same year, NABP released “Emergency and Disaster Preparedness and Response Planning: A Guide for Boards of Pharmacy.” This guide included models of plans that pharmacy boards around the country could utilize to prepare for and respond to natural disasters, as well as outlining the roles of federal, state, and local governments. These model plans include contacting suppliers of pharmaceuticals to prepare for an influx in certain locations, expanding storage space for medications, entertaining the possibility of mobile pharmacies to assist affected areas, and knowing proper disposal rules upon return to any facility that had to be abandoned due to the disaster.

Hurricane Harvey

On Friday, August 25th, 2017, Hurricane Harvey made landfall. Just two days prior to the storm hitting the state of Texas, Governor Greg Abbot declared a state of disaster for 30 Texas counties. On that same day, the Texas State Board of Pharmacy released their emergency prescription plan. This outlines almost the exact plan that was enacted by the Jefferson County pharmacists following Hurricane Katrina and the subsequent lessons learned throughout that disaster. For example, Texas’s plan included that pharmacists should not dispense more than a 72-hour supply of medication, but this was preempted by saying that if there was an emergency and more medication was needed a prescription could be given for up to 30 days according to the Texas Pharmacy Act and board rule 291.34.

Hurricane Irma

Following the devastation of Hurricane Harvey, Hurricane Irma, one of the strongest hurricanes on record, wreaked havoc on the Caribbean and the Southern United States. Irma made landfall on September 6th in Puerto Rico and the U.S. Virgin Islands and 4 days later, the hurricane hit Southwest Florida. Similar to Harvey prevention efforts, the Governor of Puerto Rico, Ricardo Rosello, and the Governor of the U.S. Virgin Islands, Kenneth Mapp, declared states of emergencies for their respective islands on the Monday preceding the storm while Florida Governor, Rick Scott, declared a state of emergency on Tuesday. Trump declared emergencies in Puerto Rico, the U.S. Virgin Islands, and Florida on the 5th of September. Like Texas, Florida and Puerto Rico were ready with emergency prescription refill statutes, one of Florida’s policies was even created shortly after Hurricane Katrina. Unfortunately, the U.S. Virgin Islands seem to have slipped through the cracks with no plan in place for handling emergency prescription refills other than the blanket regulations set forth in the Food, Drug, and Cosmetics Act (19 V.I.C. §603). While TriCare, an insurance company for service members, initiated their emergency refill plan, it seems as though anyone else has been left behind to fend for themselves. The U.S. Virgin Islands has a Board of Pharmacy which means it had access to the plans developed post-Hurricane Katrina, but it is unclear if these were utilized.

Next steps

The people of Texas, Puerto Rico, and Florida were fortunate to have a plan in place long before Hurricanes Harvey and Irma hit allowing them to receive the medications they needed in the event of an emergency. Regulations that build upon experiences of others is how progress is made. If it weren’t for the quick thinking of Jefferson County pharmacists that could handle the needs from Hurricane Katrina refugees, the implementation of plans like this would be extremely difficult. Those effected by these hurricanes could be less worried about making sure they grabbed their pill bottles and more focused on ensuring their safety during the evacuations. Pharmacists still had a course of action to make sure that everyone’s health and safety was attended to. Moving forward, the NABP should touch base with the Boards of Pharmacy in the U.S. Virgin Islands to determine how to best suit their specific prescription needs. A plan should be put in place, much like that of Puerto Rico to ensure the unique needs of island residents are attributed for.