pharmacyabroad Pharmacists key link in Dutch pandemic planning of the product by the Netherlands Medicines Evaluation Board, the Ministry of Health decided to package all 3 million courses. I Strong pharmacy network provides distribution channel for antivirals If you governed a small, densely populated country facing the H1N1 influenza pandemic, how would you prepare to distribute drugs to high-risk patients who contract the virus? The Netherlands, with 16.5 million people living on 16,034 square miles, turned to its robust network of 1,900 community pharmacies as a distribution point for oseltamivir phosphate, the active pharmaceutical ingredient (API) in Tamiflu (Roche). Pharmacists step up Community pharmacies have received 600 packets (equal to 60 courses) and began distributing the antiviral packets August 7. Patients who fall into the following risk categories receive free packets of oseltamivir with a prescription from their physician: n Children younger than 2 years n Women who are at least 4 months pregnant n People with a medical risk (i.e., those who receive the annual flu vaccination and all healthy persons older than 60 years) n People with immune disorders n Flu patients who suffer from complications Physicans were advised not to prescribe antivirals to all other patients but to encourage them to stay home and recover there if they are sick. However, if those patients have a prescription, they must pay for commercial antiviral medication out of their own pocket. Each pharmacy is allowed to order more antivirals when it has distributed half of its supply. Between August 7 and November 30, about 31.000 courses were dispensed. KNMP Antiviral Coordinator and pharmacist Jan Dirk Kroon explained that wholesalers send a weekly report to the ministry and to the Netherlands Foundation for Pharmaceutical Statistics documenting which pharmacies have been resupplied with packets and the exact amount of antivirals delivered to each pharmacy. Kroon s organization developed a formula that pharmacists use to quickly prepare a child s dosage from the amount of API in the packets. The formula has been used in 7.5% of the courses distributed. He told Today, The pandemic created a unique opportunity to demonstrate how valuable it is to have a nationwide network of efficient, easily accessible pharmacies, run by reliable and well-trained pharmacists. Carli Richard www.pharmacytoday.org Advance planning According to Sandor Beukers, Antiviral Coordinator for the Netherlands Ministry of Health, the Dutch government began preparing for a possible pandemic in 2005. A key planning decision was that distribution of antiviral drugs during such a pandemic would be regarded as part of the regular care provided by family physicians and pharmacists. Beukers recently told Pharmacy Today, Although responsibility for preparedness is a local and regional one, the ministry thought it would be best to stay as close to existing national structures as possible for the distribution of antivirals during a pandemic and not create any new structures that would have to be set up during a crisis situation. Under the aegis of the ministry, a consultant with experience in logistics and distribution of medicines was asked to lead the development of a plan with the help of the Royal Netherlands Pharmacists Association (KNMP) and wholesalers. As part of the plan, KNMP was asked if its members could prepare and distribute a government stock of oseltamivir; the association was ready. Because Roche, the manufacturer of Tamiflu, was unable to supply the antiviral in the quantity needed in 2005, the Ministry of Health procured 3 million courses of the API (besides 2 million ready-to-use products), which would then need to be dissolved in water and 4 4 Pharmacy Today january 2010 Are they covered? The Netherlands does not have socialized medicine or universal health coverage. The country has a private health insurance system. All residents are required to have health insurance and insurers are required to accept every resident. Residents pay an income-related contribution and employers contribute a compulsory payment toward the incomerelated insurance contribution of their employees. Health insurance comprises a standard package of essential health care that is determined by the Minister of Health. Residents can purchase complementary insurance if they want. For more information, see http://minvws.nl/en/themes/healthinsurance-system/default.asp. distributed to sick patients. Knowing that distribution of the API in this form would pose a logistical nightmare, officials began exploring alternative options. They consulted with scientists at the nation s universities, who suggested packaging the equivalent of one Tamiflu capsule s worth of API in aluminum-coated packets to be dissolved by the patient. This unique distribution form allowed the drug to be packaged ahead of time without worry over shelf life because it contains no additives. After a positive evaluation PT_H1N1.indd 44 12/24/09 10:42 AM