On The Cover
Loren Bonner
In late September 2024, Hurricane Helene hit Florida and then quickly made her way up into Georgia before moving over the southern Appalachians. In eastern Tennessee and North Carolina, Hurricane Helene caused historic flooding and widespread devastation. With wind gusts up to 40 to 60 mph in addition to rainfall, residents experienced extensive and long-lasting power outages.
Paul Petersen, PharmD, is the emergency preparedness director for the Tennessee Department of Health. He helps organize disaster relief for Tennessee communities and said Hurricane Helene required major coordination for pharmacy.
“With Helene, we had a variety of activities that engaged pharmacists with the board of pharmacy and the Tennessee Pharmacists Association,” said Petersen. One of the big ones was the Emergency Prescription Assistance Program for Tennessee—in place for the first time in Tennessee—to help uninsured residents replace their prescription medications and medical equipment as well as receive vaccines. This was in addition to pharmacists providing medications to both shelter residents and patients with transportation challenges and managing medication donations, which involved regulatory restrictions and coordination with the Tennessee Board of Pharmacy.
With major disasters like Hurricane Helene, the role of pharmacists continues to evolve from simply providing medications to serving in more clinical capacities.
“I’ve seen a transition more in recognizing the clinical knowledge and decision making of the profession,” said Petersen.
Pharmacists are also routinely included in official Disaster Medical Assistance Teams and other emergency response structures, as the coordinated effort with pharmacy during Hurricane Helene exemplified.
“You can see over time, especially during COVID, we all know the pharmacists’ role became so essential in providing immunizations and different PPE and also just making sure that people with chronic illnesses were being supported throughout that time,” said Sonja Pagniano, executive director of the National Community Pharmacists Association (NCPA) Foundation, during a March 2025 NCPA Foundation webinar on severe weather preparedness for pharmacies. “Now I think those roles are even more essential in expanding further. We are starting to see more nonprofits relying on pharmacists when they are going out boots on the ground responding to disasters.”
But even before the COVID-19 pandemic, pharmacists were being recognized during disasters.
Post-Hurricane Katrina legislation brought about the Pandemic and All-Hazards Preparedness Act in 2006 and subsequent reauthorizations expanded pharmacists’ emergency response capabilities during that time. In 2012, with Hurricane Sandy, pharmacists provided mobile medication services, maintained cold chains for insulin and vaccines during power outages, and coordinated with relief agencies. Then of course with the COVID-19 pandemic, pharmacists became central to testing, vaccination, and medication management like never seen before. According to a 2022 article published in JAPhA, pharmacists can be credited with providing over 50% of COVID-19 vaccinations in the United States.
More recently with the wildfires in Hawaii and California, pharmacists developed innovative medication delivery systems and remote consultation models when evacuation zones prevented physical access, Pagniano noted.
Emergency preparedness resources for pharmacists
Healthcare Ready’s RxOpen Tool
https://healthcareready.org/rxopen/
HHS emPOWER Map
https://empowerprogram.hhs.gov/empowermap
Hospital Preparedness Program
https://aspr.hhs.gov/HealthCareReadiness/HPP/Pages/about-hpp.aspx
Emergency Prescription Assistance Program
https://aspr.hhs.gov/EPAP/Pages/default.aspx
PhRMA’s Medicine Assistance Tool
https://medicineassistancetool.org/
NABP, in collaboration with member boards, created an Emergency Planning Guide for boards of pharmacy
https://nabp.pharmacy/members/board-resources/#regulatory
NCPA Foundation resources portfolio for independent community pharmacies regarding disaster preparedness, relief, response, and long-term recovery
www.ncpafoundation.org/disaster-resources-independent-community-pharmacy/
NCPDP emergency preparedness guidance and documents
www.ncpdp.org/resources/emergency-preparedness
Ready Business
Ready.gov/business
National Voluntary Organizations Active in Disaster
nvoad.org
NCPA webinar: “Severe Weather Preparedness for Community Pharmacies”
www.youtube.com/watch?v=GUm7EUEty8k
APhA webinar: “Disaster and Emergency Preparedness”
learn.pharmacist.com/learn/courses/4799/disaster-and-emergency-prepardness
APhA’s Disasters and Emergencies guide
Visit apha.us/EmergenciesHDBK for a timely guide to planning and practical strategies for rapidly evolving situations.
Evolving role
In the past, pharmacists used to primarily serve in a logistical capacity during a disaster, and now their roles have grown into so much more, according to Petersen. Pharmacists can be part of repackaging operations, they can compound pediatric formulations, or serve on the Medical Reserve Corps. During a disaster, Petersen has also witnessed pharmacists not only providing immunizations, but figuring out therapeutic alternatives during drug shortages, assisting with shelter support, inventory management, and more.
Pharmacists are integral to all the phases of a disaster—prevention, preparedness, response, and recovery.
Within one’s own pharmacy, Pagniano noted all the ways pharmacists need to respond when a disaster hits. She said safety for staff and personnel need to take priority, then pharmacists can take a patient needs assessment: “Where are patients, and are they OK?” Communication systems also need to be in place, and backups like satellite should be ready when first line systems fail.
Next, Pagniano said, pharmacists should understand the regulatory and legal compliance they need to follow when a disaster strikes.
“Watch for emergency declarations by local governments,” she said.
There are also documentation requirements for pharmacists. “Document as much as you can; have a plan in place for documenting,” said Pagniano.
Some points to consider if one’s pharmacy can’t operate fully include extending or limiting hours, providing emergency prescription refills and/or therapeutic substitutions, modifying counseling procedures, having alternative payment methods in place and/or a limited formulary, and prioritizing vulnerable patients, according to Pagniano.
However, during an evacuation, closure procedures consist of:
- Knowing the board of pharmacy requirements.
- Securing controlled substances.
- Implementing a patient notification and transfer procedure.
- Preserving pharmacy documents.
- Having a record backup in place.
- Knowing what medications are in the pharmacy’s inventory.
- Verifying security measures for the building.
Petersen said he also sees pharmacists acting as patient advocates and using their training in Mental Health First Aid to identify at-risk individuals who need help connecting to resources.
Pagniano agreed that having a certification in Mental Health First Aid can be extremely helpful when individuals in the community have lost loved ones, neighbors, and friends.
Relationships
With Hurricane Helene, Petersen said the established relationship the Tennessee Health Department already had internally with the Tennessee Board of Pharmacy and externally with the Tennessee Pharmacists Association (TPA) helped their coordination efforts.
“During a declared disaster, state governments—through the governor—can generate executive orders that identify and pause specific rules in the pharmacy space that benefit our impacted communities,” said Petersen. He said it’s important to prepare a regulatory strategy with partners with the goal of facilitating how pharmacy services will be delivered in an innovative way.
When there were pharmacy needs during Hurricane Helene’s relief and recovery phase, Petersen directed requests for assistance to TPA. “They can better inform and support their constituents by having meaningful conversations and aiding with situational awareness,” he said.
Pagniano said that pharmacists should have contacts for their state board of pharmacy as well as the National Council for Prescription Drug Programs written down when they are creating their disaster plan.
“They would be some of the first contacts you’d reach out with the local emergency teams,” she said.
In developing a disaster plan, Pagniano also added that pharmacy owners should know who their state and local emergency management agencies are. “Having their contact info is so key,” she said. “They will be the ones to help you out if you need something, or they will let you back into your pharmacy.”
Pharmacy owners should also be in contact with wholesalers and suppliers or vendors during a disaster. “They can do so much in times of disasters and have a pulse on the logistics and supply side of things,” she said. “They can make sure you get up and running sooner and can connect you with additional resources if you need that.”
Limitations
Petersen said they are in the process of reevaluating the lessons learned during Hurricane Helene—another important step in disaster preparedness.
One big limitation, which is often seen in numerous disasters, is mitigating regulatory restrictions state to state when mobile pharmacy units are sent out. “There are lots of barriers,” said Petersen. Sometimes chain pharmacies can provide this better than independents are able to.
However, upon a state’s request and with a declared state emergency, the National Association of Boards of Pharmacy (NABP) runs the NABP Verify program to make sure “out of state pharmacists meet ‘in good standing’ licensure status in another jurisdiction that enables them to practice in or into their state with an abbreviated registration process.” The NABP Verify program enables the vetting of the “in good standing” and reduces the administrative burden on state agencies.
Hurricane Helene relief efforts in North Carolina were an example of this, said Bill Cover, BSPharm, associate executive director or accreditations and inspections, digital health and licensure at NABP. In the NABP database, 316 pharmacists were listed who have full scope of practice authority in North Carolina “whether it occurs outside or within the borders of the state until the emergency declaration is rescinded,” said Cover.
“Some changes are coming in how we administer the emergency response version of the Verify program, but the principals above and no cost to the emergency responder will not change,” Cover said.
He also added that some states have asked for NABP to include licensed technicians and pharmacist interns to the program. ■
The basics: What to keep in mind when creating your pharmacy’s disaster preparedness plan
Policies and procedures:
- Different policies for different types of emergencies.
- Clear and defined decision-making authority and communication protocols.
Physical infrastructure:
- Backup power systems.
- Secure storage for medication, especially controlled substances.
- Cold chain maintenance.
- Physical security and access controls.
Human resources/pharmacy staff:
- Updated staff emergency contact information.
- Clear roles and responsibilities for emergencies.
- Cross training for essential functions.
- Personal emergency plans for staff.
- Communication trees and backup contacts.
- Psychological first aid awareness.
- Mental Health First Aid certification, if possible.
Technology and communications:
- Manual operating procedures in place.
- Patient record access contingencies.
- Communication systems and a satellite option.
- Contacts for state and local emergency management agencies; utility companies; transportation services; local health care providers; wholesalers and suppliers/vendors; state board of pharmacy; and NCPDP.
- Documentation systems/storage and backup servers.
- Full system backup of both Rx and POS systems.
- Pictures and/or videos of pharmacy before disaster.
Testing and training:
- Annual or semi-annual drills.
- Lessons learned documented.
- Risk assessment survey (identifies top three disasters that are likely to happen in one’s area).
Other considerations:
- Legal “cooperative agreement” with another pharmacy on an “in-case of emergency basis.”
- Good rapport with business neighbors.
- Storage sites for items in case of emergency.
- Insurance policy considerations.