We have either been there or will be at some point—dependent on a lifesaving medicine and in a scenario in which the pharmacist can’t fill the prescription. This is what happened to Kevin Houdeshell in 2014. The Ohio man found himself in a dire situation on New Year’s Eve when his pharmacist could not be reach his doctor to refill his prescription for insulin. Kevin continued on with life and work, but then the flu-like symptoms hit. Unbeknownst to the relatively new diabetic, who was diagnosed at age 27, he was falling into Diabetic Ketoacidosis (DKA), a toxic state that develops when the body cannot properly metabolize glucose. He died a few days later.
His parents were stunned to learn what had happened. “In the wee hours of the morning, we are wondering how can your son, or anyone, stand in front of a pharmacy desk and be turned away for a life-sustaining medication,” Kevin’s father, Dan Houdeshell, wondered. A year after Kevin died, he felt the need to do something about what happened. He reached out to a local TV reporter who was friends with Kevin and sat for a heart-wrenching interview, along with his wife and Kevin’s sister. “That single TV interview fast tracked Kevin’s Law in Ohio,” Houdeshell believes.
“Kevin’s Law,” also known as “Howdy’s Law,” took effect in March 2016, thanks to the work of the Houdeshells and Ohio Senator David Burke. It authorizes pharmacists to dispense a 30-day supply of insulin or another life-saving medication without a prescription if the following conditions are met: there is an expired prescription on file; the patient’s doctor cannot be contacted; and the refill is not for a controlled substance. The legislation, which includes drugs used to treat hypertension, diabetes, migraines, depression, post-transplant, thyroid disease, HIV, heartburn, epilepsy, and allergies, limits the release of the prescription to once per year.
So far, the following states have either succeeded, or are working toward some form of Kevin’s Law: Ohio, New Jersey, Florida, Arkansas, Arizona, Wisconsin, Illinois, Idaho, Pennsylvania, Michigan, Tennessee, Oregon, California, Maryland, New Hampshire, South Carolina, Kentucky, Oklahoma, Washington, and Minnesota.
The most recent activity occurred during a Colorado hearing for HB19-1077, which targets chronic maintenance medications like insulin. At the January 23, 2019, hearing, one of Kevin’s cousins testified in front of the Colorado House Committee about Kevin. “She had the room in tears,” Dan said on Twitter. The bill passed out of committee to the House floor with a vote of 11-0. An emergency clause was also passed, which allows for the bill to become law as soon as it is signed by the governor instead of waiting the usual ninety days.
Pharmacists in Ohio and other states are thrilled to see so many states adopt the law. “It’s hard to quantify if and how many times it has saved a life,” says Antonio Ciaccia, Director of Government & Public Affairs at the Ohio Pharmacists Association. But he is “aware of hundreds of anecdotes of patients benefiting from the law in Ohio” and is working hard to raise public awareness about the legislation.
Many pharmacists are relieved to have more authority to help in pressing circumstances. An Outpatient Clinical Pharmacist for the Internal Medicine department at Cleveland Clinic said, “The [law]allows me to provide much more timely patient care,” adding that is “a huge win for [his]profession.” Another pharmacist , Dana, shared, “It was a great feeling to utilize this new law, and more so, to be able to help my patient have access to her medication when she needed it the most.” But pharmacist Mary Ann R. Dzurec, also in Ohio, notes that many pharmacists do not seem to be aware of the law. There is still much work to be done to inform the profession about it.
Some critics of the law have asked why patients don’t simply plan ahead. Why even get into that situation, especially knowing of potentially devastating consequences? Proponents of Kevin’s Law note that there are always unexpected factors, especially when traveling and around holidays, and that patients often find themselves without a refill through no fault of their own. The problem may be an unorganized or overwhelmed doctor’s office staff. Or, an individual may be too sick to go to the doctor regularly in order to have the prescription renewed.
The consequences for those who cannot fill a lifesaving prescription include costly emergency room visits, medication rationing, complications, and even death. Testimony at the Colorado hearing conveyed this urgency. One witness statement read, “I had to go to the ER and stay in the hospital since I can’t skip my blood thinners ever. That means death. I lost my legs because of blood clots, so I can’t play with that. Some people think medication is optional for people with disabilities. It’s not. Ever.” Another statement read, “I’m a severe asthmatic, which means life or death. Ran out of lifesaving medication over Christmas, needed a refill, dr’s office was closed. Had to go to the ER.” One statement described a person’s efforts to track down an old doctor to ask for a favor in calling in what was needed—in this case, transplant meds: “I would have likely gone into rejection without them for a weekend.”
The consequences for those who cannot fill a lifesaving prescription include costly emergency room visits, medication rationing, complications, and even death.
Houdeshell is thrilled about the success in Colorado, but explains that there is still much work to be done even in states that have passed legislation. “It’s important to note some versions of the law have flaws,” he says. “ Some states allow only one refill, EVER. That is not acceptable.” He adds that improvements to laws occur at a slower pace than he likes. “Having larger diabetes organizations with more power and connections should and would get this across the country much quicker— not sure we can do another five years.” The fight is exhausting. He and his loved ones have had to reach deep down to find the strength to deal with their son’s death and the advocacy in his memory.
What has kept him going this long is seeing others take charge in their own states. Senator Anthony R. Bucco of New Jersey was able to fast track a similar bill after hearing of a 27-year-old who nearly died after being denied insulin because of an expired prescription. At the time, only 72 hours’ worth of medication could be dispensed according to protocol. A vial or pen of insulin far exceeds this limit, leaving the patient empty-handed.
Deborah Healy of Pennsylvania is another leading example of advocacy. Having a son of her own with Type 1 diabetes, Healy was deeply moved by Houdeshell’s story. She met with state representatives and helped to pass Kevin’s Law in the Keystone State. Healy, who has also helped to pass laws promoting DKA awareness, advises others wanting to enact change at the state level to find their local representative using a simple search tool, then bring to the meeting with this person an agenda, examples of similar laws, statements on how those laws are working, and details on protocols and handwritten letters of those impacted. Once a law is passed, residents can ask their state pharmacists’ association to issue an email to all members to bring attention to the changes.
The Houdeshells will continue to support these efforts. “Obviously it has been a long five years and Kevin’s Law keeps the emotions higher than we want, but we realize the bigger picture and all of the good this is doing,” says Dan. “Kevin would do anything for anyone—he deserves this.”