Swift action through close collaborations
Working with hospitals and academic medical centers to expedite discharges by rapidly identifying patients who could be treated at home.
Working with payors to remove barriers to same-day discharges, such as prior authorization for nursing visits for acute patients.
Working with physician offices to avoid admissions by rapidly identifying acute and chronic patients who could be treated at home.
To discharge a patient or start care in the home, contact Coram at 1-800-423-1411.
Vaccine deployment and administration
CVS Health is prepared to play a prominent role in administering COVID-19 vaccinations to health care workers and residents of long-term care facilities, as well as to the general public once the vaccine is available for general distribution through a partnership with the Centers for Disease Control and Prevention (CDC) as one of the COVID-19 Vaccination Program Providers.
In-home nursing care
Virtual assessments and consults
24/7 clinical phone support
Seamless start of IV therapy at home
Assess and identify
Case review to quickly identify patients
Eligible patients identified
Refer and authorize
Patient referral to Coram
Site of care authorization
Virtual consults with medical doctors
Steps we’re taking to safely care for patients
Here are a few highlights about how we’re protecting patients and Coram colleagues.
Contacting patients before their scheduled visits to screen for possible infection or exposure to COVID-19
Ensuring adequate supplies of PPE for patient care staff
Leveraging video conferencing technology to train, educate and assess patients when a face-to-face visit is not required
Enhanced cleaning protocols at all Coram sites
Non-essential personnel or visitors are not allowed into any of our facilities
Practicing social distancing in branch and ambulatory infusion suites (AIS) locations and requiring corporate staff to work from home
Coram will help pilot the administration of COVID-19 therapy to eligible patients in long-term care facilities and at home
Coram will begin administering a limited supply of bamlanivimab for eligible COVID-19 patients at risk for severe complications from the virus in seven cities and their surrounding communities starting on December 3, 2020 in a pilot program.
We will begin administering bamlanivimab for the treatment of COVID-19 in seven cities and their surrounding communities starting on Thursday, December 3, 2020, as new COVID-19 infections continue to rise rapidly in these regions.
- Los Angeles (patients living within 75 miles of our Los Angeles pharmacy)
- Milwaukee (patients living within 75 miles of our New Berlin pharmacy)
- Minneapolis (patients living within 75 miles of our Mendota Heights pharmacy)
- Tampa, Florida (patients living within 75 miles of our Tampa pharmacy)
Following the pilot, and as drug supply increases, we plan to scale this solution to additional markets in areas of greatest need.
To be eligible for bamlanivimab, patients must not be hospitalized, have tested positive for COVID-19, be within 10 days of symptom onset, at least 12 years of age or older, weighing at least 40 kilograms or 88.2 pounds and at high risk for progressing to severe COVID-19 and/or hospitalization as required by the U.S. Food and Drug Administration.
- High-risk factors are defined by the EUA and include age, BMI and chronic conditions.
- Bamlanivimab is not authorized for patients who are hospitalized or who require oxygen due to COVID-19. Patients currently on an oxygen therapy who require increased oxygen flow rate because of COVID-19 also are not authorized to take bamlanivimab.
Patients can be referred to Coram for treatment from the hospital, urgent care or telemedicine appointment, LTC facility or their primary care physician.
Currently, the federal government has purchased a limited supply of bamlanivimab for the treatment of COVID-19 and has contracted with us to help distribute and administer it. During the pilot phase of this program, Coram is working with both government and commercial payors to ensure appropriate, timely and affordable access.
During the pilot phase of this program, there is no out-of-pocket cost to patients for this care.
Bamlanivimab and similar therapies are administered as a single-dose IV infusion. This kind of therapy needs to be distributed and administered by health care providers.
Our nationwide Coram nursing infrastructure enables us to administer the IV therapy in patient homes or LTC facilities to help meet the growing demand for these new treatments.
In the home or at an LTC facility, our Coram nurses will provide hands-on care to patients. If a patient has a reaction to the infusion, our experienced clinicians are trained in anaphylactic protocols and emergency support.
During the 2 ½-hour-plus visit, nurses will:
- Assess the patient
- Establish IV access
- Prepare the medication, as directed
- Administer the infusion for one hour
- Monitor the patient for the duration of the infusion and for one hour post-infusion observation.
The Coram team will also follow up with the patient within 48 hours of the infusion and again 14 days and 28 days post-infusion to see how the patient is doing and assess for any adverse drug reactions, symptoms and reactions.
Coram will provide nursing visit records to the primary health care provider within 72 hours. Coram also will provide additional reporting to HHS and the FDA, as required.
Possible side effects of bamlanivimab include anaphylaxis and infusion-related reactions, nausea, diarrhea, dizziness, headache, itching and vomiting.
Every patient referral must include specific bamlinivimab acute infusion reaction orders. The nurse will have the following available during the treatment, if needed:
- Epinephrine: 0.3 mg SQ/IM
- Diphenhydramine: 25-50 mg IV/IM
- Methylprednisolone: 125 mg IM
- Albuterol MDI 90mcg/act: 1-2 puffs
Coram has been providing safe and effective monoclonal antibody infusion therapy for more than 35 years. Our experienced clinicians are trained in anaphylactic protocols and emergency support.
We have a dedicated intake team to handle all new referrals for bamlanivimab.
Bamlanivimab should be administered as soon as possible after a positive test for COVID-19 and within 10 days of symptom onset. Prior authorization is not required.
To refer your patient to Coram for treatment:
The dedicated intake team will verify that the patient:
- Has a positive COVID-19 test
- Is within 10 days of symptom onset
- Lives in one of the seven pilot markets where we have the drug
- Will be receiving care within 75 miles of the local Coram pharmacy
If that initial intake screening criteria are met, we will email or fax you the bamlanivimab for COVID-19 fax cover sheet. We ask that you:
- Complete the fax cover sheet in its entirety and fax it back to us on the same day so the patient remains in the treatment window.
- Send the following documents with the fax cover sheet to complete the referral
- Written prescription for bamlanivimab 700 mg administered over at least 60 minutes
- History & physical
- Recent clinical notes, including the reason for therapy
- List of current medications
- Anaphylactic kit orders (required for all patients)
Our Rhode Island Central Pharmacy will review the submitted documentation to confirm the patient meets the clinical criteria. Pharmacy staff will then coordinate with the local Coram pharmacy to dispense and coordinate nursing.
As part of the Administration’s Operation Warp Speed, Coram has contracted with HHS to initiate a monoclonal antibody pilot to administer the EUA treatment and monitor patients within their own homes or at long-term care facilities. Coram will help pilot the administration of a limited supply of the IV therapy bamlanivimab to those patients meeting the EUA criteria.
This pilot is intended to help keep patients out of inpatient and hospital settings to alleviate pressure on the health care system and preserve important hospital resources for more critical patients as COVID-19 case rates continue to surge.
This program expands the work CVS Health is already doing with HHS and Operation Warp Speed as we prepare to also help administer COVID-19 vaccines when available.
Yes. We have instructed our staff to follow any new procedures set forth by individual facilities to safely discharge patients to the home and/or ambulatory infusion suite (AIS) for care. We also will take necessary preventive measures as required (e.g., donning personal protective equipment [PPE] such as a mask, gown and gloves as appropriate) when discharging patients.
For the duration of the coronavirus state of emergency, Coram providers are now using video conferencing technology to train, educate and assess patients requiring infusion care in inpatient or home settings when Coram providers are not able to enter a facility and/or when a face-to-face visit is not required. We also have how-to therapy teaching videos available to our patients.
Yes. We plan to continue caring for patients in the home and AIS, but are taking proactive measures to help minimize community-based transmission of COVID-19.
All patients will be contacted by Coram before a scheduled visit. We will ask patients a few questions over the phone to help us understand if they have been exposed to COVID-19 or could be infected, including:
- Are they or a member of their household experiencing a fever, cough or shortness of breath?
- Have they or a member of their household had close contact with anyone diagnosed with COVID-19; and
- Have they or a member of their household recently traveled outside the state our outside the country in the past 14 days?
Depending on a patient’s answers to our questions, we may need notify the patient’s provider of their symptoms or travel. Coram may also need to reschedule any AIS appointments to a patient’s home if clinically appropriate. Also, the nurse may need to wear PPE such as a mask, gown and gloves, before entering the patient’s home. This will help to prevent the spread of the virus.
Patients are receiving communication in their prescription orders about this screening process.
For patient and staff protection, we are currently limiting the number of visitors or people coming with patients for their visit to no more than one at a time. If a visitor shows signs of a cold or flu, the visitor will be asked to leave.
At Coram, we are closely monitoring this situation and have plans in place. Our staff are highly trained at screening for and managing infectious diseases. We are asking all Coram patients about their recent travel and where the people close to them have traveled, possible exposures to COVID-19, as well as about any signs of illness. To help protect our patients and colleagues and ensure that nurses, pharmacists and staff are available to care for patients we are also taking the following steps:
- Coram is following CVS Health enterprise policy and restricting business travel.
- Our corporate staff is working from home and practicing social distancing in branch and AIS locations.
- We have enhanced cleaning protocols at all Coram sites.
- Until further notice, non-essential personnel or visitors are not allowed into any of our facilities.
- We have instructed all field staff to suspend visits to our AIS and pharmacy branch locations until further notice, unless a personal visit is critical for patient care.
- We are transitioning to a paperless delivery and onboarding process. We will no longer be asking new patients to sign and return hard copies of the required start of care forms. They will be asked to sign these forms electronically through Adobe Sign.
If a Coram nurse makes a home visit, the nurse may need to wear PPE such as a mask, gown and gloves, before entering the home. This will help to prevent the spread of the virus, if it is present.
For those residing in an area with travel restrictions or a curfew, we are working with local officials and law enforcement and have documentation to help ensure we are still able to deliver medications and care to our patients.
We have robust plans in place to help ensure we are able to continue providing important care to all of our infusion and nutrition patients should we start to see colleague absenteeism due to illness or quarantine.
Currently, all Coram pharmacies are operating at full capacity with no interruption in service. We do not see any disruptions to the supply chain, as a result of COVID-19, that will affect our ability to fill prescriptions. We are also filling medications for longer durations when possible and clinically appropriate.
Our national delivery partners are also working to implement new policies for deliveries requiring signatures, including for shipped medications, which can help our patients adhere to recommended social distancing practices and avoid potential exposure to the virus.
For example, in lieu of obtaining actual signatures, UPS will now enter a code and the name of the recipient so that patients do not have to physically sign via the UPS hand-held device, which can help minimize contact.
If a branch employee tests positive for COVID-19, they, along with any co-workers who were exposed, will be sent home immediately and placed under quarantine consistent with CDC guidelines and placed on paid leave. The branch will then close for cleaning to disinfect the premises following established protocols and CDC guidelines.
Every branch has a designated backup branch so Coram can continue to provide uninterrupted service to patients. In the event the backup reaches capacity, our central pharmacy, located in Rhode Island, is equipped to process prescriptions for most locations nationwide.
In addition, we have a work from home strategy in place for all of our branches. If one or more employees become infected and must be quarantined, staff members currently working at home can go to the branch to cover the workload.
The U.S. Food and Drug Administration (FDA) is closely monitoring medications that are made throughout the world. We are working closely with our supply chain providers to manage and monitor pharmaceutical supplies.
Coram staff is continuously monitoring state and local government guidance to ensure we are coordinating and aligning Coram's response, while providing hands-on care to patients in all states, with the proper safety precautions.
This is a very fluid situation. We are proactively calling all patients prior to service. We are also putting information in all outgoing patient medication orders about our screening process. In addition, Coram-specific FAQs are available on our COVID-19 Resource Center for Patients.
We are communicating to providers via email, fax and by phone, informing them of our ability to help discharge their patients from the hospital or avoid hospitalization all together. Coram recognizes the critical need to keep immunocompromised patients from unnecessary infectious exposure and higher exposure settings like hospitals and skilled nursing facilities (SNF). We are well positioned and prepared to support pharmacy consultation, first dosing in the home and out-patient line coordination where needed.
Coram locations in New York meet the New York Department of Health Home Nurse screening requirements. The following are those requirements:
Twice daily (i.e., before shift starts and after shift ends), nurses self-screen per the following instructions:
- What is your temperature? (Temperatures >100 degrees F are considered febrile)
- Do you have any respiratory symptoms, including cough, shortness of breath or sore throat?
- Have you been exposed to someone who has tested positive for COVID-19, or is a person under investigation (test results pending) for COVID-19?
The staff should follow the instructions below if the answer to any of the questions above is “yes.”
Colleague is exhibiting symptoms of the virus (cough, trouble breathing and fever)
- Colleague should follow the usual call out procedures and notify his/her leader
- Colleague should contact his/her healthcare provider
- Colleague should remain at home and should not return to work until (s)he is symptom-free for at least 24 hours and (s)he has been cleared by the provider (if possible)
Colleague begins to exhibit symptoms during work hours
- Colleague should notify his/her leader and contact his/her health care provider
- Colleague should go home and stay at home, considering themselves in quarantine
- Colleague should contact the HR Coronavirus Call Center at 1‑866‑298‑5206
- Colleague should not return to work until cleared per his/her health care provider and/or the local Department of Health guidelines
Contact Tracing will be instituted by the colleague’s leader and the following information will be tracked:
- Last date worked
- Date tested
- Date received test results
- Everyone who came in contact with for exposure? (Think about meetings, breaks/lunches, came in contact with in the past 72 hours, both employees, vendors, patients, etc.)
- Any hospitalizations
This policy may apply in other areas of the country if mandated/appropriate.
CVS Health’s response to COVID-19
The CVS Health® Enterprise Response and Resiliency (ERR) and Infectious Disease Response teams (IDRT) meet daily to track and address the spread of COVID-19; to align our policies and procedures with the latest guidance from the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and state and local governments; and to continuously update our mitigation and recovery strategies.