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Planning for Chronic Disease Medications in Disaster: Perspectives From Patients, Physicians, Pharmacists, and Insurers

Published online by Cambridge University Press:  15 August 2013

Kelley A. Carameli*
University of California Los Angeles, School of Public Health, Los Angeles
David P. Eisenman
University of California Los Angeles, Division of General Internal Medicine and Health Services Research, Los Angeles
Joy Blevins
Los Angeles County Department of Public Health, Emergency Preparedness and Response Program, Los Angeles
Brian d'Angona
University of California Los Angeles, School of Public Health, Los Angeles
Deborah C. Glik
University of California Los Angeles, School of Public Health, Los Angeles
Address correspondence and reprint requests to Kelley A. Carameli, DrPH, CHES, VA National Center for Organization Development, 11500 Northlake Dr, Suite 230, Cincinnati, OH 45249 (e-mail



Recent US disasters highlight the current imbalance between the high proportion of chronically ill Americans who depend on prescription medications and their lack of medication reserves for disaster preparedness. We examined barriers that Los Angeles County residents with chronic illness experience within the prescription drug procurement system to achieve recommended medication reserves.


A mixed methods design included evaluation of insurance pharmacy benefits, focus group interviews with patients, and key informant interviews with physicians, pharmacists, and insurers.

Results and Discussion

Most prescriptions are dispensed as 30-day units through retail pharmacies with refills available after 75% of use, leaving a monthly medication reserve of 7 days. For patients to acquire 14- to 30-day disaster medication reserves, health professionals interviewed supported 60- to 100-day dispensing units. Barriers included restrictive insurance benefits, patients’ resistance to mail order, and higher copay-ments. Physicians, pharmacists, and insurers also varied widely in their preparedness planning and collective mutual-aid plans, and most believed pharmacists had the primary responsibility for patients’ medication continuity during a disaster.


To strengthen prescription drug continuity in disasters, recommendations include the following: (1) creating flexible drug-dispensing policies to help patients build reserves, (2) training professionals to inform patients about disaster planning, and (3) building collaborative partnerships among system stakeholders. (Disaster Med Public Health Preparedness. 2013;7:257-265)

Original Research
Copyright © Society for Disaster Medicine and Public Health, Inc. 2013 

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