For Clinicians | Emergency Preparedness in Older Adults

The Three Parts That Are Yours

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Medically reviewed and edited by Kristen Carpenter, PA-C

Most of your patients over 55 are doing well. Pickleball four mornings a week, a cruise booked for October, a flight out to see the grandkids.

Then something changes the math. A first prescription for blood pressure or thyroid or a statin. A fall that took a lot longer to come back from than it would have at 40. A hospitalization nobody saw coming. Nothing catastrophic, but important enough to stay with them, and afterward a question shows up that never occurred to them at 30: what would I do if I couldn’t get to care?

At 30 nobody asks that. You take nothing, and you have never once considered slipping on your own front steps. By 60 it’s a pertinent question that is top of mind and being discussed at games on the court, on the deck of the ship, and with a whole peer group running the same arithmetic. “What if I can’t get this medication anymore? What if I get hurt again and am far from care?”

So they prepare, off the same checklist a 30-year-old would use. She isn’t going to bring that medical preparation to you as her clinician or pharmacist. Three parts of this prep are yours anyway: how long a fill she can get on the prescriptions she already takes, whether the medication reference list in her bag is sufficient, and what she decides to keep on hand for the illnesses that haven’t happened yet.

We’re a team of physicians, PAs, and pharmacists, and we field this question constantly from patients in exactly that age band. Today we’re covering what makes appropriate medical preparation different for this age group than for any other.

Your patients are already preparing, and it’s happening without us

This is not behavior we need to talk anyone into. In a 2019 national poll of adults 50 to 80, 82% said they had a week’s supply of their medications on hand, and 72% had a week of other health supplies.¹ Three-quarters had lived through at least one major emergency in their lifetime. Fewer than a third had actually assembled an emergency kit, and among the patients who depend on electrically powered medical equipment, only one in four had backup power.

So the intent is close to universal and the execution is uneven. The medication half is the part they’ve done best, which makes sense, because it’s the part they already think about every morning.

Then there’s the number that should get our attention. Only 40% had discussed their emergency plans with their own family. If six in ten haven’t raised it with the people they live with, the odds they raised it at their annual visit are worse. The planning is happening, the supplies are being bought, the medication list is being written, and no clinician or pharmacist has looked at any of it.

What makes their preparation different is that it’s mostly a medication problem

For most people under 40, preparation is a supply question. Water, food, a flashlight, a first aid kit, plus some way to hear what’s happening. Medication appears on those checklists, but it isn’t what they’re built around, and for a healthy 30-year-old that doesn’t take any chronic meds it is the right call.

It stops being the right call somewhere in the late fifties. Polypharmacy in adults 65 and older climbed from 23.6% in 1999 to 2000 up to 43.0% by 2017 through March 2020, and the average number of prescriptions per person went from 3.0 to 4.3.² In twenty years, taking five or more prescription medications went from about a quarter of this population to nearly half of it.

So her grandson’s version of this and her’s are not the same exercise. His is bandages, ibuprofen, and a flashlight. Hers is four or five prescriptions she can’t skip for a week, plus everything on his list.

And her four or five medications she does take are not equal, which is the part she may not be able to differentiate on her own. A week without a statin is a non-event. Levothyroxine has enough half-life to forgive a few missed days. A beta blocker stopped abruptly is much more time-sensitive. So are anticoagulants, antiepileptics, and insulin. It’s easy to treat all of them as one undifferentiated pile labeled ‘my medications.’ Sorting that pile into what tolerates a gap and what doesn’t only take 2 minutes and helps flag what is most important to have enough of hand on to prevent a disruption in care.

Part one: how long a fill she can get

Let’s take the easiest of the three first. When a patient asks whether she can get more of a medication she already takes, that’s a dispensing-interval question. Same drug, same dose, same indication, same prescriber. Only the interval changes, and nothing about her pharmacologic exposure does. That is, speaking for general chronic medications. This isn’t the same for controlled substances or acute cases like antibiotics.

So write it long. For a patient who’s worried, you can write a year of refills on a chronic medication up front and let her decide how much to have on hand at any one time. She can pick up a month, or three, or the whole year if her plan allows it. Some plans will cover a full year at once for travel, which is worth asking about rather than assuming.

If you do nothing else with this article, default your chronic prescriptions to 90 days. Your patients end up with a real amount on hand without anyone having to plan for it, and they stop driving to the pharmacy and standing in line twelve times a year for a medication that hasn’t changed in a decade.

Part two: the list in her bag

The AGS tip sheet says to carry a written medication list that contains all brand and generic names and doses a patient takes regularly.³ That’s the right instruction, and it’s the one she’s most likely to have done badly, because most people don’t have this written down and just cite it from memory. What comes out is “the little white one for blood pressure” and a dose she’s half sure about. And to make matters more complicated many patients pharmacy shop for the best price on medications so the Rx are spread across pharmacy chains and multiple prescribers with no central EMR hub all healthcare professionals can access.

A clearly printed, and accurately updated med list is usable by a pharmacist who has never met her. Drug, strength, and directions for each item, and the condition each one treats. Indication is important to remember and not leave off either. Add her allergies, adverse reactions to previous medications, and your office phone number while you’re at it.

This simple list costs almost nothing. Your MA can print the med list at check-out in a minute. Just make sure to add the medications prescribed by other HCPs she sees. Better than that, have her ask her pharmacy(ies) for a printed profile, because the dispensing record shows what she has actually been filling and when, which is often closer to the truth than what’s in the chart. Reconciling those two against each other is the whole exercise that is most helpful. If they disagree, you and she have learned something worth knowing whether or not a disaster ever shows up.

Part three: what she keeps on hand for what hasn’t happened yet

This is the part that earns the skepticism, and it’s also the part where the answer moves with the decade. A healthy 58-year-old on one antihypertensive is not a Beers patient⁴. A 78-year-old on four medications, with a creatinine clearance you’d want in front of you first, is a different conversation. The difference isn’t age by itself. It’s the list she’s already on.

A single new drug isn’t generally a big deal.  It’s when another is added to a polypharmacy list that there’s more for it to bump into for drug-drug interactions and drug-condition interactions. And the kidneys are slower, so the same dose hits harder. The 2023 Beers criteria are still current as of this summer if you want the reference.

And, since we are talking about appropriate medical preparation, if she’s in a situation where she can’t reach a healthcare professional she’s the one who decides whether to take it with nobody to ask. The bottle won’t tell her when not to. You will, ahead of time, while she’s feeling fine. Anything she keeps on hand is for an emergency, after she’s tried to reach a provider, and she only knows that because somebody told her. That’s the argument for having the conversation about how to prep well instead of saying no and sending her to figure it out herself with the internet chat rooms as guide.

The drug-by-drug version of what medications are appropriate for seniors in emergency kits is its own article and we’re writing it: what to look for in medical preparation after 70, and which contents actually matter at that age. 

The missing middle layer

Here’s the structural problem underneath all three parts. Care in this country is all or none. Either she reaches a clinician and gets a prescription, or she’s on her own with whatever happens to be in the house. Nothing sanctioned sits in between, which is how a reasonable 64-year-old asking a reasonable question ends up choosing between a no from her prescriber and whatever she finds on her own.

Appropriate medical preparation is the name for that middle layer. One bounded step, taken ahead of time, by a clinician, for the disruptions that actually happen to people her age: the week she can’t get to the pharmacy, the storm, the trip that puts her four hours from a clinic. Or international travel.

It isn’t a replacement for the clinician or the pharmacist she already has. It doesn’t manage her chronic conditions, it doesn’t follow her labs, and it makes no decision at the point of use. It’s what’s on the shelf for the times you aren’t reachable, used in an emergency, after she’s tried to reach someone.

If a patient in that age band asks and you’d rather not be the one to build an appropriate medication kit with her, you can send her to us at Jase.com. A licensed provider reviews every request and writes every prescription, so it’s a handoff rather than a workaround.

We’ll keep publishing where we draw the lines, including the lines that run through our own products. Right now that conversation is happening on the pickleball court with nobody clinical in it. That’s the part we’re trying to fix.

Sources

1. National Poll on Healthy Aging. Emergency Planning among Older Adults. University of Michigan Institute for Healthcare Policy and Innovation, with support from AARP and Michigan Medicine. Fielded May 2019, published September 4, 2019. n = 2,249 adults ages 50 to 80. https://www.healthyagingpoll.org/reports-more/report/emergency-planning-among-older-adults
2. Innes GK, Ogden CL, Crentsil V, Concato J, Fakhouri TH. Prescription Medication Use Among Older Adults in the US. JAMA Internal Medicine. 2024;184(9). NHANES, January 1999 through March 2020, 14,917 adults aged 65 and older. Polypharmacy, defined as 5 or more prescription medications, rose from 23.6% to 43.0%; mean medications per person rose from 3.0 to 4.3. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2820722
3. American Geriatrics Society. Tip Sheet: Emergency Preparedness for Older Adults. HealthInAging.org, September 2019. https://www.healthinaging.org/tools-and-tips/tip-sheet-emergency-preparedness-older-adults
4. By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society. 2023;71(7):2052-2081. doi:10.1111/jgs.18372. https://pubmed.ncbi.nlm.nih.gov/37139824/

For Clinicians | Antibiotic Eye Drops for Pink Eye

What to Do When a Patient’s Pharmacy Is Closed

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Medically reviewed and edited by Kristen Carpenter, PA-C

“I’m from out of town and I just took my last pill from another pharmacy. Can you give me a refill? I reaaaaally need this med”

I’ve had this happen to me dozens of times every ski season in the mountain town pharmacy I worked at for years. Friday at 4:50pm when all offices are closing up shop for the weekend. People don’t always have the pharmacy closest to them open and ready with their prescriptions. It happens for all sorts of reasons.  A hurricane or a holiday weekend. A staffing shortage that closed the pharmacy early with no sign on the door guaranteeing when they will open again. A power outage. Or the chain closed a batch of locations in one fell swoop when they went under.

Today we’re talking about closed pharmacies, and about how much of this is preventable from our side of the encounter. First, what you can put in place ahead of time so a closed pharmacy is an inconvenience instead of a crisis. Second, what you and your patient can do once the door is already locked and Monday is three days away.

How much medication do your patients actually have on hand?

Here’s how I think about this as a pharmacist. Picture a patient on a 30-day prescription. Their plan lets them refill once they’ve used about 75 percent of it, so somewhere around day 22. Most people go pick it up right then, because that’s when the pharmacy texts them that it’s ready. So they walk out with 30 new pills while a week of the old bottle is still sitting at home. Seven or eight pills, if it’s a once-a-day medication.

That’s the whole cushion. Seven pills. Nobody chose that number. It falls out of a 30-day fill and a refill window, and that’s the only reason it’s seven. If you’re prescribing rather than dispensing, this is the part you never see, because the refill math happens weeks after the patient leaves your office.

Now here’s what bugs me. Nobody agrees on the number. The Red Cross says keep a 7-day supply of medications.¹ The CDC’s own emergency kit checklist says at least two weeks.² FEMA’s Build a Kit page lists prescription medications and never names a number at all.³ Seven days is the one that propagated out to every state and county checklist, and seven days is what the patient already had by accident. The one study I know of that looked at what a household actually needs put the number at 14 to 30 days, and said the way to get there is longer fills.⁴ The CDC is closest to right and nobody is following it.

What to put in place ahead of time

These are workflow changes, not clinical ones. 

• Default to a 90-day fill on stable chronic medications. Same drug, same dose, same annual quantity. What changes is how often that patient has to stand in a line for it.
• Synchronize the refill dates. A patient on five chronic medications with five different fill dates is making five trips a month and getting five separate chances to run out on the wrong weekend. Write them all in one visit, aligned to a single date. The AAFP has recommended this for years as practice management, and it’s the same action with a different reason attached.5 Your MA can call the pharmacy to align the first cycle so it doesn’t eat your afternoon.
• A year is on the table, and most people don’t know it. For chronic medications that aren’t controlled substances, a prescriber can authorize up to a year of a patient’s own validated prescription to fill at a single time. Plenty of prescribers assume that isn’t allowed. Insurance likely will only cover 90 days regardless of what you wrote. It’s something for the patient to ask about, not something to promise them.
• Put the list on paper. Every medication in the house, with drug, dose, prescriber, and pharmacy. A pharmacist who has never met your patient can work from that list. Without it we’re guessing, and we don’t fill on a guess. Simple solution is to just print their med list from your EMR and give it to the patient instead of having the MA re-write everything by hand.

Can another pharmacy fill your patient’s prescription?

Usually yes, and more easily than most patients expect. Inside a chain, any store can pull up that patient’s prescriptions and fill them. Controlled substances get more complicated, but even then the new store can see the prescription and who wrote it, which is enough to start the conversation.

Outside the chain, it comes down to whether the patient brings the bottle. When someone handed me their bottle from another pharmacy, I could verify the prescription off the label, get them an emergency supply, and call their office Monday for a formal script. Without the bottle, at 8:55 on a Sunday night, there was nothing I could do for them because I couldn’t just take their word for it that they were taking that specific Rx.

So the counseling is four things:

• Bring the bottle to the pharmacy where you are. The label is what makes verification possible.
• Call ahead instead of walking in. Five minutes before close is the worst possible time to ask.
• Give lead time. “I have three pills left” on Thursday morning opens doors that “I’m out” on Friday at 5:59pm does not.
• Expect to pay cash. Insurance usually won’t process a fill this way, and a patient shouldn’t expect coverage. Great time for a discount card.

Two extra things to know. The first is the 72-hour emergency supply. A pharmacist’s authority to dispense without prescriber authorization varies enormously by state, and a meaningful number of states give pharmacists none at all. Several states that do have public-health-emergency provisions require a governor’s declaration to activate them, so the advice is weakest in the situation patients actually find themselves in: an ordinary Friday, nothing declared, nothing activated. Look up your own state before you tell a patient to count on it.6 It’s really more for epic natural disaster situations.

The second is Schedule II. There is no refill mechanism under federal law, so a patient who runs out on the road needs a new written prescription, not an authorization. A prescriber can verbally authorize an emergency quantity limited to the emergency period, with the written prescription delivered to the pharmacy within days. This is federal, so a state’s emergency dispensing rules don’t create a workaround. For patients on stimulants or opioids, that’s a conversation to have before the trip, not during it.7

Ahead of time there is one thing you can do. Federal rules let you issue multiple Schedule II prescriptions totaling up to a 90-day supply, each one marked with the earliest date a pharmacy may fill it, where your state permits it and where you judge there’s no undue diversion risk.⁷ It isn’t a refill and the regulation is careful to say it isn’t an expectation, but it’s the closest thing these patients have to the 90-day fill everyone else gets.

Everything above is a workaround

Now that we’ve covered the basics, look at what this article has covered. A longer fill, because the default one is too short. A bottle carried to a stranger’s counter, because there’s no other way to verify. A 72-hour supply that depends on which state line your patient happens to be standing behind. Every one of these gets around the same absence. There’s no sanctioned step between reaching a clinician and being on your own with whatever is in the cabinet. Care is all or none. Either your patient gets to someone who can write or verify, or they’re counting seven pills on a Friday night.

That missing step is what we build at Jase, and the category has a name: appropriate medical preparation. For a short list of well-understood conditions, the clinical work happens on the front end. A licensed provider reviews the request and writes the prescription before anything ships, so the patient isn’t hunting for a prescriber at 8:55 on a Sunday night. It’s for emergency use only, after first seeking the assistance of a qualified healthcare provider.

This is in no way a replacement for primary care. Chronic disease management, complex diagnoses, and the ongoing relationship belong with you. What a JaseCase holds is the acute layer a disruption creates, the infection or injury that shows up during the week nobody can reach a pharmacy. The chronic half of the problem is the one you solve, in your office, with the four things in the list above.

If you’d rather refer

Some of you will want to work out the day-supply and standby-prescribing questions yourselves, and you should. Some of you have a full panel and no room for a new category of conversation inside a 15-minute visit or a line at the counter. Either is a reasonable place to land. If it’s the second, send them to us at Jase.com, where one of our licensed providers reviews the request and writes anything prescription that gets filled.

The criteria are the part we owe you. Which conditions qualify, what we decline to prescribe ahead of time and why, and how we handle the cases that don’t fit cleanly. We publish that here as we settle it, so you can argue with it or borrow it.

TL;DR

Patient calls, their pharmacy is closed:

• Same chain nearby? Any store can pull their profile and fill it.
• Different pharmacy? Bottle in hand, call ahead, expect cash.
• Schedule II? No refill exists. New written prescription, or a verbal emergency quantity with the written script following in a few days.
• No bottle and nobody reachable? A state emergency supply, if your state has one.

Every workaround in this article exists because there’s no sanctioned step between reaching a clinician and going without. We’re building that step and publishing the criteria as we set them. Until it exists, the shortest path runs through the script you write: ninety days instead of thirty, synced to one date, printed on a list your patient can hand to a stranger.

Sources

1. American Red Cross. Survival Kit Supplies. “Medications (7-day supply) and medical items.” https://www.redcross.org/get-help/how-to-prepare-for-emergencies/survival-kit-supplies.html 
2. CDC. Emergency Kit Checklist: Pregnant Women, Infants, and Children. Updated April 30, 2026. “Prescription medications (at least 2 weeks supply).” https://www.cdc.gov/children-and-school-preparedness/resources/emergency-kit-checklist-pregnant-women-infants-and-children.html 
3. FEMA. Build A Kit, Ready.gov. Updated July 1, 2026. Lists prescription medications among additional emergency supplies with no day-supply figure given. https://www.ready.gov/kit 
4. Carameli KA, Eisenman DP, Blevins J, d’Angona B, Glik DC. Planning for chronic disease medications in disaster: perspectives from patients, physicians, pharmacists, and insurers. Disaster Medicine and Public Health Preparedness. 2013;7(3):257-265. Los Angeles County sample. “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.” Health professionals in the study supported 60- to 100-day dispensing units to reach the recommended 14- to 30-day reserves. https://pubmed.ncbi.nlm.nih.gov/23103395/ 
5. Sinsky TA, Sinsky CA. A Streamlined Approach to Prescription Management. Family Practice Management. 2012;19(6):11-15. The physician renews all of a patient’s chronic medications, excluding narcotics and benzodiazepines, at the annual comprehensive care visit; estimated saving of one to two hours of physician and staff time daily. https://www.aafp.org/pubs/fpm/issues/2012/1100/p11.html 
6. Healthcare Ready. A Review of State Emergency Prescription Protocols. September 18, 2022. 16 of 51 jurisdictions have no laws or regulations pertaining to emergency prescriptions; 23 allow a general emergency refill; 12 have public-health-emergency-specific provisions, of which 10 activate on a governor’s declaration. More than half of states allow only a 72-hour emergency supply or none at all. https://healthcareready.org/a-review-of-state-emergency-prescription-protocols/ 
7. 21 CFR 1306.12(a): “The refilling of a prescription for a controlled substance listed in Schedule II is prohibited.” 21 CFR 1306.12(b): a practitioner may issue multiple Schedule II prescriptions totaling up to a 90-day supply with earliest-fill dates marked, where permissible under state law. 21 CFR 1306.11(d): an emergency oral Schedule II prescription is limited to the quantity needed for the emergency period, and the prescriber must cause a written prescription to be delivered to the dispensing pharmacist within 7 days. https://www.ecfr.gov/current/title-21/part-1306