Overcoming Engineering Challenges to Enable Commercial-Scale mRNA Vaccine Manufacturing

Increasing production capacity may necessitate the facility to cater for higher hazardous area category (e.g., H-Occupancy) design features, such as specialized building construction and potential blast zones. [...]an assessment should cover: * Quantification of flammable material use for production steps, including buffer preparation and LNP storage * Equipment and facility cleaning strategies that contribute to the facility flammable materials inventory * Impact of HVAC design to avoid hazardous atmospheres (e.g., full fresh air), use of local exhaust ventilation (LEV) or fume hoods * Solvent distribution methods (e.g., closed solvent delivery and waste removal systems) * Location of solvent bulk storage outside of the processing area/ facility, and piping in what is necessary plus removing spent solvent in a timely manner (e.g., piped transfer to a waste tank for removal by a specialist contractor). At present, the process cannot be fully single-use, so thought needs to be put into the cleaning and sterilization processes, plus the analytical support infrastructure needed for reusable product-contact surfaces. [...]it is recommended that for each mRNA project, consideration is given to the following aspects to determine the link between the equipment available and the facility design: * Need for custom/proprietary equipment * Independent production rooms with "through-wall" buffer transfer through iris ports in from logistics corridor (Buffer Prep/Hold) * Room electrical classification needs versus process step. * Equipment selection versus electrical and fire code requirements * Benefits and limitations of implementing single-use technologies, given that the process will be hybrid (with stainless steel). [...]the limited capacity for outsourcing of supporting functions, such as facility environmental monitoring or product sterility testing, should be considered during concept design.

Preparing Pandemic Vaccine Capacity

Among the challenges of a pandemic is the need to scale up to billions of doses, at a larger scale than typically needed for vaccines, from raw materials all the way through to the materials for the containers for fill/finish. Having adequate raw materials, building and staffing the facilities, and tech transfer are all keys to success. [...]we can plug into existing infrastructure, including services (gas, water, waste, etc.) as well as analytics and quality labs." Emergent BioSolutions says that its flexible CDMO capacity deployment model can respond quickly to demand fluctuations. The company's facilities in France, Switzerland, and the US are working on the project;at CordenPharma Colorado, unique high-pressure chromatography systems usually used for manufacturing peptides have been reallocated for purifying lipids.

Impact of Pandemic on Permanent Procedures

Conducting virtual audits, conducting effective virtual training, and enhancing communications with suppliers to ensure an uninterrupted supply chain are among the changes implemented to maintain operations, stay compliant, and continue manufacturing medically necessary products. The necessity for virtual audits was to allow companies and regulators to continue to evaluate the compliance stature of manufacturers while respecting stay-at-home and social distancing requirements that prevented in-person site audits. Some of these venues are free, and some require a registration fee. supply chain quality Enhanced communication with suppliers to ensure an uninterrupted supply chain has also become a priority during the pandemic.

Following Guidelines During a Crisis

The guidance states, "These preventative measures can include steps to prepare personnel such as: * "Educating employees on topics such as, in the case of a pandemic, personal hygiene (hand washing and coughing and sneezing etiquette), social distancing, and appropriate use of sick leave * "Encouraging employees to get immunized as appropriate by providing information on local vaccination services or by offering on-site vaccination services, if reasonable * "Providing information for and encouraging employees to develop family emergency preparedness plans * "Reviewing CGMP [current good manufacturing practice] regulations regarding appropriate sanitation practices and restriction of ill or sick employees from production areas (see 21 CFR [Code of Federal Regulations] 211.28)" (2). Examples include: * "Production equipment routine maintenance * "Utility system performance checks and maintenance (e.g., air temperature, lighting, compressed air) * "Environmental monitoring of facilities such as cell culture, harvesting, and purification rooms during production * "Stability testing for certain drug products and components * "Periodic examinations of data and of reserve samples" (2). EMA, Guidance on the Format of the Risk Management Plan (RMP) in the EU-in Integrated Format, EMA/164014/2018 Rev.2.0.1 accompanying GVP Module V Rev.2 Human Medicines Evaluation (EMA, 31 October 2018).

Community Pharmacist Provision of Non-Dispensing Services in Health Professional Shortage Areas.

Individuals living in primary care health professional shortage areas (HPSAs) experience health inequities. Community pharmacists are healthcare professionals with an opportunity to provide care to underserved populations. The objective of this study was to compare non-dispensing services provided by Ohio community pharmacists in HPSAs and non-HPSAs. METHODS: An electronic, IRB-approved 19-item survey was sent to all Ohio community pharmacists practicing in full-county HPSAs and a random sample practicing in other counties (n=324). Questions assessed current provision of non-dispensing services as well as interest and barriers regarding such services. RESULTS: Seventy-four usable responses were received (23% response rate). Respondents in non-HPSAs were more likely to recognize their county's HPSA status than those in an HPSA (p=0.008). Pharmacies in non-HPSAs were significantly more likely to offer 11 or more non-dispensing services than those in HPSAs (p=0.002). Nearly 60% of respondents in non-HPSAs reported starting a new non-dispensing service during the COVID-19 pandemic compared to 27% of respondents in full HPSA counties (p=0.009). Most commonly reported barriers to providing non-dispensing services in both county types included lack of reimbursement (83%), workflow (82%), and space (70%). Respondents expressed interest in learning more information about public health and collaborative practice agreements. CONCLUSION: While the need for non-dispensing services is great in HPSAs, community pharmacies in full-county HPSAs in Ohio were less likely to provide these services or begin novel services. Barriers must be addressed so that community pharmacists can provide more non-dispensing services in HPSAs to increase access to care and promote health equity.

Benefits and challenges of electronic prescribing for general practitioners and pharmacists in regional Australia.

OBJECTIVE: To explore the benefits and challenges of electronic prescribing (e-prescribing) for general practitioners (GPs) and pharmacists in regional New South Wales (NSW). METHODS: This qualitative study utilised semistructured interviews conducted virtually or in-person between July and September 2021. SETTING AND PARTICIPANTS: General practitioners and pharmacists practising in Bathurst NSW. MAIN OUTCOMES: Self-reported perceived and experienced benefits and challenges of e-prescribing. RESULTS: Two GPs and four pharmacists participated in the study. Reported benefits of e-prescribing included improvement in the prescribing and dispensing process, patient adherence, and prescription safety and security. The increased convenience for the patients was appreciated particularly during the COVID-19 pandemic. Challenges discussed were how the system was perceived to be unsafe and insecure, costs of messaging and updating general practice software, utilisation of new systems and patient awareness. Pharmacists reported the need for education to patients and staff to minimise the impact of inexperience with the novel technology on workflow efficacy. CONCLUSION: This study provided first insight and information on the perspectives of GPs and pharmacists 12 months after the implementation of e-prescribing. Further nationwide studies are required to consolidate these findings; provide comparisons with the system's progress since conception; determine whether metropolitan and rural health care professionals share similar perspectives; and shed light on where additional government support may be required.

The Psychological Antecedents to COVID-19 Vaccination among Community Pharmacists in Khartoum State, Sudan.

Background and Objectives: Little is known regarding the 5C psychological antecedents to COVID-19 vaccination among pharmacists in low- and middle-income countries. This study aimed to assess the acceptance of COVID-19 vaccination and its psychological antecedents among community pharmacists in Khartoum State, Sudan. Materials and Methods: A cross-sectional study was conducted from July to September 2022. A self-administered questionnaire was used to collect data about sociodemographic and health status characteristics, vaccine acceptance, and the 5C psychological antecedents to vaccination. Stepwise logistic regression analysis was conducted, and results were presented using odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Results: A total of 382 community pharmacists participated in the current study, with a mean age of 30.4 ± 5.6 years. Nearly two-thirds of the participants (65.4%) were females, and the majority (74.9%) have received or intended to receive the COVID-19 vaccination. Vaccine acceptance was significantly associated with the following psychological antecedents to vaccination: confidence, complacency, constraints, and calculation (p < 0.001). Results of the logistic regression showed that confidence in vaccines [OR = 6.82 (95% CI = 3.14-14.80)], conspiracy beliefs [OR = 0.44 (95% CI = 0.23-0.85)], and constraints to vaccination [OR = 0.18 (95% CI = 0.06-0.56)] were the significant determinants of vaccine acceptance. Conclusion: The study revealed important predictors of COVID-19 vaccine acceptance that can be used to guide policymakers in designing target-oriented interventions that can improve the vaccine acceptance rate among community pharmacists in Sudan. These findings suggest that interventions to promote vaccine acceptance among pharmacists should focus on building confidence in vaccines and providing accurate information about the safety and efficacy of the COVID-19 vaccine, and reducing constraints to vaccination.

Covid-19 distance and online learning: a systematic literature review in pharmacy education.

The Covid-19 outbreak necessitated the implementation of social distancing mechanisms, such as the enforcement of lockdowns in numerous nations. The lockdown has disrupted many parts of everyday life, but this unusual event has particularly affected education. The temporary closure of educational institutions ushered in dozens of new reforms, including a shift into the distance and online learning. This study investigates the transition from traditional education in physical classrooms to online and distance and online learning in pharmacy education during Covid-19, especially about the challenges and benefits of distance and online learning. We did Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for literature sources between 2020 and 2022 (n.14). The study elaborates on how the transition has influenced teachers and students of pharmacy education. The research also summarizes several recommendations, which may assist in minimizing the adverse impacts of lockdown and encourage streamlined processes to distance and online learning, particularly in pharmacy education.

A Cross-Sectional Survey on the Post-Pandemic Acceptability of Pharmacist-Delivered Telehealth Services Among HCV-HIV Patients.

The COVID-19 pandemic enhanced the use of telehealth as a means of delivering services to patients who required continued and uninterrupted care. This helped to reduce readmission to hospitals where COVID-19 hospitalization was prioritized. Patients with HCV and HIV and other chronic diseases require this type of care. This study evaluated the post-pandemic acceptability of pharmacist-delivered telehealth services among HCV and HIV monoinfected and coinfected patients in Washington DC. This was a cross-sectional study conducted in a community pharmacy setting in Washington DC whose primary outcome was the acceptability of pharmacist-delivered telehealth services through a proposed platform(docsink). A validated questionnaire, borrowed from the literature was used to determine telehealth acceptability, measured as behavioral intention, among patients who receive care from this pharmacy. The study recruited 100 participants. Descriptive statistics were conducted as well as bivariable and multivariable analyses to assess predictors of telehealth acceptability. In the unadjusted model, PU/EM (OR 0.571, 95% confidence interval (0.45-0.73), P < .0001)), PEOU(OR 0.72, 95% confidence interval (0.61-0.85)) and IM(OR 0.733, 95% confidence interval (0.62-0.87), P = .0003)) were significant predictors of behavioral intention. Overall, the study found that lower Perceived Usefulness/Extrinsic Motivation scores decrease the odds of intending to use pharmacist-delivered telehealth (OR = 0.490, 95% confidence interval (0.29-0.83), P = .008). This study determined that the impact of perceived usefulness and extrinsic motivation was critical to the acceptance of pharmacist-delivered telehealth among a predominantly Black/African American study population.

Community Pharmacy Practice During COVID-19 Pandemic: A Perspective From the Middle East.

The coronavirus disease 2019 (COVID-19) pandemic poses serious challenges to pharmaceutical care services, and innovative responses by community pharmacists and regulatory bodies are needed. The experience in Jordan, located in the Middle East, is shared in this article in light of available international guidelines to provide insight into the efforts made by the pharmacists to safely maintain pharmaceutical services during the current pandemic. In addition, unique roles played by community pharmacists in other countries are discussed to shed light on the important role of community pharmacists in this outbreak.

Perspectives about Spiritual Care in Pharmacy Practice: A Community-based Survey.

Background: Addressing religious and spiritual needs are important components of holistic healthcare. Little is known about the general public's perspectives about pharmacists providing spiritual care (SC). Objectives: To explore how community members perceive, experience, and desire pharmacist-provided SC. Method: IRB approval was obtained for this observational, cross-sectional study. Adults receiving COVID-19 vaccinations at an immunization clinic completed an investigator-designed 33-item online survey. The survey measured respondents' perspectives about and experiences with pharmacist-provided SC, as well as demographic characteristics. Results: Of the respondents (n = 261), 57% were female and 46% were Hispanic/Latino. Most (59%) agreed that their religion/spirituality would be important to them if they were ill; 64% also agreed that it would be helpful for a pharmacist to know about patients' religious/spiritual beliefs pertaining to their healthcare, and 60% agreed that pharmacists should provide SC to patients who request it. While 96% indicated that they had never talked to a pharmacist about a spiritual or religious matter related to their health or medication, 96% also indicated that no pharmacist had asked to pray with them. These results are contextualized perhaps by the finding that 76% reported having no professional relationship with a pharmacist. Conclusion: Respondents often reported an openness to receiving SC from pharmacists. Most respondents, however, had not received SC from a pharmacist. Future studies should be conducted to better understand patient preferences for pharmacist-provided SC.

A hospital within a hospital: An innovative pharmacy model to improve the continuum of care.

DISCLAIMER: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To describe the implementation of a contracted pharmacy service model for a co-located long-term acute care hospital (LTAC). SUMMARY: Historically, most LTACs have been free-standing healthcare facilities, but there is an increased trend towards the co-located LTAC ("hospital within a hospital") model.Co-located LTACs represent a solution for the management of patient throughput within a health system, with optimized bed capacity at the host hospital, increased revenue under a prospective payment system, and reduced readmission rates. A co-located LTAC will likely share resources with the host hospital, including ancillary departments such as pharmacy services, through a contractual model. Operationalization of pharmacy services in a co-located LTAC presents unique challenges in the integration of pharmacy services. Pharmacy leaders at Houston Methodist collaborated with executive leadership and other healthcare disciplines to expand services from a free-standing LTAC to a co-located LTAC at the academic medical center location. The contracted pharmacy service operationalization processes in the co-located LTAC comprised licensure and regulations, accreditation, information technology enhancements, a staffing model, operations/distribution services, clinical services, and a defined quality reporting structure. Admissions from the host hospital to the LTAC consisted of patients requiring long-term antibiotic administrations, pre- and post-organ transplant care, complex wound care, oncologic-related treatment, and neurological rehabilitation for strengthening and continued care. CONCLUSION: The framework described here offers guidance to health-system pharmacy departments to support establishment of a co-located LTAC. The case study outlines challenges, considerations, and processes for implementation of a successful contracted pharmacy service model.

Role and impact of a clinical pharmacist in an ambulatory reproductive endocrinology and infertility clinic.

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Advances in the work of multidisciplinary teams for the care of patients with severe uncontrolled asthma. A post-COVID vision (TEAM 2.0 project). / Avances en el trabajo de equipos multidisciplinares para la atención al paciente con asma grave no controlada. Una visión post-COVID (Proyecto TEAM 2.0).

Asthma is a chronic respiratory disease with a high health, social and economic impact, particularly in the case of Severe Uncontrolled Asthma (SUA). For this reason, new strategies are especially necessary to improve its approach, with a personalized approach to each patient and from a multidisciplinary perspective, in addition to integrating the new telemedicine and telepharmacy practices promoted as a result of the COVID-19 pandemic. In this context, the TEAM 2.0 project ("Work in Multidisciplinary Asthma Teams") has been developed, following the TEAM project carried out in 2019, with the aim of updating and prioritizing good multidisciplinary work practices in SUA in a post pandemic context and analyze the progress made. A coordinating group, made up of eight multidisciplinary teams of hospital pharmacists, pulmonologists, and allergists, carried out an updated bibliographic review, sharing of good multidisciplinary practices, and analysis of advances. Through five regional meetings with other experts with experience in SUA, the good practices identified were shared and subjected to debate, evaluation and prioritization. In total, 23 good multidisciplinary work practices in SUA, grouped into five work areas: 1) Organization of work in multidisciplinary teams, 2) Patient education, self-management and adherence, 3) Health results, data monitoring and persistence, 4) Telepharmacy and experiences implemented during the COVID-19 pandemic and 5) Training and research, were evaluated and prioritized by 57 professionals from the field of Hospital Pharmacy, Pulmonology, Allergology and Nursing. This work has made it possible to update the roadmap of priority actions to continue advancing in optimal models of care for patients with AGNC in a post-COVID-19 context.

Preparing for the market entry of adalimumab biosimilars in the US in 2023: A primer for specialty pharmacists.

DISCLAIMER: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: The impact of the market entry of adalimumab biosimilars on clinical practices and specialty pharmacies is explained. A roadmap is also provided for how pharmacists can successfully navigate this landscape. SUMMARY: Biosimilars have previously been introduced as a mechanism to help curb biologic expenditures, with biosimilars undergoing an abbreviated regulatory approval process that focuses on biosimilarity and generating product competition. Adalimumab is currently the leading product in the biologics market, generating approximately $20 to $30 billion in sales worldwide consecutively from 2019 to 2021. Many adalimumab biosimilars are slated to enter the market in 2023 and become available for patient use. However, compared to other biosimilars, adalimumab biosimilars have several unique considerations, such as interchangeability and concentration, that will impact pharmacy practices and workflows. Because pharmacists embedded in clinical practices and specialty pharmacies will be significantly involved in the processes relating to adalimumab biosimilar implementation, adoption, and use, a primer on understanding the various adalimumab biosimilar products available and considerations surrounding these products with regard to workflow and patient use is critical. Several resources are also provided to help pharmacists successfully navigate the adalimumab biosimilar landscape. CONCLUSION: The biosimilar landscape continues to evolve, and 2023 will see the launch of several adalimumab biosimilar products, which vary with regard to formulation, concentration, and interchangeability status. Pharmacists are well positioned to educate providers and patients about this landscape and help implement an efficient workflow to support adalimumab biosimilar adoption and use.

Response to COVID-19 Pandemic: Managing Inpatient Pharmacy Services at King Abdulaziz Medical City - Jeddah.

Since early December 2019, the coronavirus disease 2019 (COVID-19) has been relentlessly spread worldwide and has hit the healthcare systems with terrible force. Pharmacists play a vital role in the healthcare system in providing medicines, therapeutics, vaccines, clinical services, and other pharmaceutical care services to patients. Therefore, to ensure all these services continued at King Abdulaziz Medical City - Jeddah during the COVID-19 pandemic, the Department of Pharmaceutical Care initiated a departmental crisis preparedness plan, as a part of general hospital preparedness plan. It started with adjusting medication dosing time, instituting a daily medication refill process, working remotely, expanding the use of automation, and modifying employee schedules. Other actions included the following: handling drug shortages, placing restrictions on some medications, using personal protective equipment, changing routine practices of pharmacy aides, revising the medication delivery process, starting a contingency training program, and restricting pneumatic tube operation. We took guidance from the Ministry of Health, our own institute's experience, World Health Organization recommendations, updated scientific research, and the American Society of Health-System Pharmacists regulatory updates. This article aims to describe how health services, policies, and systems were applied and adapted to address a specific problem while maintaining all pharmacy employees' safety. This article reviews the inpatient pharmacy's particular needs and responses to these needs to meet the COVID-19 pandemic challenges.

The Effect of Pharmacist-Led Telemedicine on A1c Reduction During the COVID-19 Pandemic.

Purpose: Diabetes remains a prevalent metabolic chronic condition. The pandemic promoted the use of telemedicine for patients with chronic conditions. Telemedicine offers innovative methods to achieve glycemic control for these patients. This study evaluates the effectiveness of telemedicine with pharmacists in reduction of glycated hemoglobin (A1C) for patients with diabetes. Methods: This study (n = 112) was a single-center, retrospective study that evaluated the effectiveness of patients enrolling in pharmacist-led diabetes management utilizing telemedicine during the COVID-19 pandemic. Patients with an A1C >9 mg/dL were contacted for telemedicine with the pharmacy team. The three groups included: patients agreeing to the telemedicine visit (n = 28), patients that declined the telemedicine visit (n = 42), and patients that did not answer the telephone when offered the telemedicine visit (n = 28). Results: Our study revealed a significant change in the primary endpoint A1C (2.6 + 2.4, p = 0.0144) for the patients who accepted telemedicine visits when compared with the other study groups. The secondary endpoints, changes in A1C (when evaluating employment status, number of clinic visits, number of chronic conditions, gender, race) and changes in body mass index, revealed no significant changes. Conclusion: Diabetes management using telemedicine with pharmacists impacts glycemic control in patients with type 2 diabetes. This study demonstrates patients who accepted pharmacist-led telemedicine had a reduction in A1C. Further research may reveal long-term benefits on clinical outcomes after utilizing this service during the COVID-19 pandemic.

Changes in anticoagulant and antiplatelet drug supply at US hospitals before and during the COVID-19 pandemic (2018-2021).

PURPOSE: Antithrombotic agents have a role in coronavirus disease 2019 (COVID-19) treatment, but the pandemic disrupted medication supply. This study examined changes in the volume of oral and parenteral anticoagulant and antiplatelet medications at US hospitals during the pandemic. METHODS: IQVIA National Sales Perspective (NSP) data was used to determine the monthly volume of anticoagulants and antiplatelets purchased at US hospitals between January 2018 and February 2021. Mean monthly medication volumes, reported as extended units (EUs), and year-over-year changes in medication volume were determined. A single-group interrupted time series analysis was used to evaluate changes in the rate of growth of monthly medication volumes before (January 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic. RESULTS: Overall, there was a 43.4% decline in the total volume of anticoagulants and antiplatelets at US hospitals in March 2020, driven by a decrease in heparin volume. Mean monthly volumes decreased significantly (P < 0.05) for parenteral anticoagulants (-106,691,340 EU [95% CI, -200,033,910 to -13,348,780]), oral anticoagulants (-354,800 EU [95% CI, -612,180 to -97,420]), and parenteral antiplatelets (-391,880 EU [95% CI, -535,420 to -248,330]). During the pandemic, the monthly volume of oral anticoagulants, parenteral anticoagulants, and parenteral antiplatelets grew significantly more than in the prepandemic period. This growth was primarily seen in volumes of apixaban, argatroban, enoxaparin, heparin, eptifibatide, and tirofiban. Apixaban and heparin volumes continued a prepandemic uptrend, while argatroban and eptifibatide volumes reversed trend. CONCLUSION: Rapid changes in anticoagulant and antiplatelet volume at US hospitals during the COVID-19 pandemic highlight the need for institutional protocols to manage fluctuating medication volume demands.

Impact of ICER Assessments on Payer Decision Making in the United States

Objectives: To evaluate how payers utilize Institute for Clinical and Economic Review (ICER) assessments to inform coverage or formulary decisions. Method(s): Double-blinded, web-based survey was fielded through Xcenda's research panel, the Managed Care Network, from June to July 2022. Result(s): A total of 51 payers from health plans (n=27), integrated delivery networks (n=12), and pharmacy benefit managers (n=12) participated in the survey. When assessing the usefulness of ICER's value assessment framework (VAF) to inform formulary decisions within their organizations, 57% of payers indicated it was extremely/very useful, 33% indicated somewhat useful, and 10% indicated not at all/not very useful. Most respondents (73%) agreed that ICER assessments are aligned with their organization's internal assessment. Utilization of ICER's VAF was most prevalent in high-cost drug or disease states (78%), rare/orphan disease states (71%), and oncology/hematology disease states (67%). Payers reported less use in primary care disease states (29%), COVID-19 (8%), and digital therapeutics (4%). In the last 24 months, 20% of payers reported ICER's recommendations often influenced coverage decisions, 59% indicated occasional influence, and 22% indicated no influence. In the last 24 months, payers indicated the top 5 ICER assessments that influenced their coverage decisions included high cholesterol (38%), Alzheimer's disease (36%), atopic dermatitis (33%), multiple myeloma (31%), and chemotherapy-induced neutropenia (28%). ICER assessments that were less impactful included beta thalassemia (3%), digital health technologies (3%), and supervised injection facilities (3%). Payers reported using ICER assessments to inform both expanded and restricted coverage decisions. Conclusion(s): Payers find ICER's VAF useful to inform their organization's formulary decisions. ICER's assessments often align with payers' internal assessments and are most frequently utilized for high-cost drugs or disease states. Payers indicate ICER assessments have affected both expansion and restriction in their coverage policies.Copyright © 2023

Study of Pharmacists' Awareness Regarding Coronavirus Disease (COVID-19) in Ukraine

Objectives: Data showed that during the SOVID-19 pandemic the pharmacy is the first place for patient care. The purpose was to study the awareness of pharmacists about the COVID-19 for 2021-2022 in Ukraine to provide complete and quality care. Method(s): Survey was developed to determine the level of knowledge of pharmacists regarding the main symptoms, methods of diagnosis, treatment and prevention of uncomplicated forms of the COVID-19 by using Google form. The heads of pharmacies, pharmacists in eight regions of Ukraine were involved. The research period was December 2021 - December 2022. Result(s): We received, 725 completed questionnaires from 8 regions of Ukraine, of which 69.7% were pharmacy managers, 12.0% were pharmacists, and 18.3% were intern- pharmacists. Of the surveyed pharmacists, 95% called the method of airborne transmission, but 4.7% believe that the coronavirus is transmitted by the contact-household method, and 0.3% - transmissible. We found that 100% of respondents correctly named the main indicators of the condition of a patient with the COVID-19. However, only 95.4% of pharmacists correctly defined the concept of saturation, which requires improvement of information support. For the symptomatic treatment of uncomplicated forms, 91.7% of respondents correctly determined that Paracetamol, Ibuprofen are for the symptomatic treatment of uncomplicated forms, but 8.3% of pharmacists named other drugs. Assessing the need to take antibiotics, 88.5% of pharmacists gave the correct answer, but 5.5% believe that the reason for prescribing antibiotics is an increase in body temperature, and 5.4% named a decrease in saturation, 0.6% - dry a cough, that does not meet the requirements of thee national guideleines Covid-19. Conclusion(s): We found that pharmacists are 100% well-informed with the symptoms and causes of the Covid-19. However, it is necessary to improve the provision of information about the requirements for the treatment of uncomplicated forms of Covid-19 and the dispensing of antibiotics from pharmacies.Copyright © 2023