Expecting the Unexpected: How Specialty Infusion Providers Prepare for Natural Disasters

The rising frequency and severity of natural disasters across the United States disrupt not only infrastructure, but also critical healthcare delivery systems. For patients managing chronic, complex, or rare conditions, interruptions in access to essential medications and therapies can compromise their health—and, in some cases, threaten their lives. In this environment, specialty infusion providers must have a robust and actionable disaster preparedness strategy to ensure patients continue receiving the therapies they rely on.

A plan for wildfires, earthquakes, and other natural disasters is a requirement for all specialty pharmacies to be accredited. However, to be truly effective, that plan must go beyond sitting on an intranet or in a policy binder—it should be a living document, reviewed regularly and updated consistently, as each new disaster uncovers unexpected circumstances and necessary improvements for the plan’s effectiveness.

At California Specialty Pharmacy (CSP), an Acelpa Health company, our disaster preparedness plan was put to the test during the California wildfires in January 2025. This real-world challenge underscored the value of our internal planning and reinforced the critical role of planning ahead with flexibility, creativity, and strong partnerships.

The Challenges of Natural Disasters

According to the National Oceanic and Atmospheric Administration (NOAA), the United States experienced more than $115 billion in weather and climate disasters in the past five years,¹ a significant increase from previous decades that places a profound pressure on healthcare providers.

For specialty pharmacies, natural disasters present very specific challenges that impact operations and the ability to provide timely delivery of essential medications to the patients we serve. Tracking the location of each patient, communicating with providers and payors, handling technology and supply chain disruptions, and coordinating alternative shipment and delivery logistics—all require internal preparation for and real-time awareness of what needs to be done to provide seamless care in a crisis.

The key to meeting these challenges and reducing medication disruptions is in a resilient disaster plan supported by proactive planning before the disaster occurs.

Strategic Foundation for Disaster Preparedness Planning

Disaster preparedness is most effective when grounded in the core strengths that define specialty pharmacy practice.

1. Patient Prioritization:

The stakes are high when it comes to maintaining specialty medication access before, during, and after a natural disaster. Patients who rely on temperature-sensitive biologics, infusion drugs, or medications requiring strict adherence may face hospitalizations, adverse outcomes, or even loss of life if their access to essential medication is interrupted.

Identifying high-risk patients in affected areas and intervening early is imperative. This begins with proactive outreach, including calling those patients to expedite refills and coordinating with providers in advance of an approaching disaster, if at all possible. Specialty pharmacies can also support a smooth continuation of care by working with payors and providers to help streamline prior authorizations for patients who may need medication refills during a disaster. They also should follow the Board of Pharmacy emergency rules to guide “special circumstance” service during a natural disaster.

Clear, consistent communication is key. During the wildfires, CSP’s call center maintained daily contact with patients regarding their medication deliveries before and during the disaster. We leveraged multiple channels including phone calls and emails, to communicate with patients. And in cases where they couldn’t be reached, we asked providers if they knew how to reach their patients. Our sales team kept providers informed of our current status and actions being taken, as well as our plan for continuing to deliver medication to ensure that all aspects of patient care were addressed.

One lesson we learned quickly during the wildfire disaster was that each patient’s medication delivery situation was different. On the first day of the fires, medications that were already out for delivery had to be returned. Our logistics team worked tirelessly throughout the crisis to adapt and find the safest way to deliver medications if patients were displaced from their homes. The situation required an ability to think and make adjustments on the fly. We used additional packaging and extra ice to make sure medications lasted a bit longer if the patient did not have access to a refrigerator. And for some patients displaced to hotels, we sent infusion nurses to hotel rooms to help with “home” infusions.

One notable example of the team’s ingenuity involved a patient in urgent need of a biologic infusion that could not be shipped through traditional methods. CSP collaborated with a local infusion center, coordinated with the prescribing physician, and arranged for hand-delivery of the medication—ensuring the patient received therapy within 48 hours, despite the chaos of the surrounding fires.

Throughout the emergency, CSP’s operations group and patient care coordinators were dedicated to understanding the specifics of each patient’s unique situation and finding the most effective way to provide medication and supplies without disruption.

2. Operational Logistics:

During a disaster, the word “seamless” probably doesn’t come to mind when discussing operations. Natural disasters can disrupt the entire pharmaceutical supply chain, and managing these interruptions requires tremendous flexibility and the ability to creatively problem solve.

Our experience has shown that advanced preparation is critical. Whether it’s back-up staffing, medication refrigeration and storage, transportation, power, water, or supplies, knowing your options can make all the difference. Stockpiling critical medications and supplies outside the hazard zone is essential, while cultivating and strengthening relationships with multiple wholesalers and third-party logistics partners preserve access to inventory throughout a disaster. Strategic partnerships with national and regional delivery organizations can also help redirect medication and supply deliveries.

A building evacuation sub-plan also warrants attention to prepare for a swift relocation and operational shift of equipment, staff, and secure data resources.  Consider what emergency equipment to have available, such as generators, to retain operations at the current location.

Digital tools also play a critical role in business continuity and should be part of any preparedness strategy. Cloud-based pharmacy management systems enable remote order entry and fulfillment, while secure messaging platforms facilitate collaboration across locations.

Establishing partnerships with geographically separate pharmacies adds an extra layer of data protection. For example, CSP, as part of Acelpa Health, will help transfer the script to one of our affiliates if we cannot fulfill due to a technological issue. It’s equally important to document and communicate activities performed at alternative sites to ensure accurate recordkeeping once operations are restored.

3. Risk Assessment:

Integrating risk assessments into disaster planning enables specialty pharmacies to protect patient access to medications and maintain operational continuity.

Reviewing and understanding regulatory considerations, patient population characteristics, and geographic vulnerabilities such as fire zones and flood plains can help direct your approach. Outlining the legal framework for emergency operations, including HIPAA, DEA, and Board of Pharmacy guidelines should also be part of your disaster preparation plan.

Cybersecurity is also an integral component to the plan, to ensure that data encryption and access controls are maintained even in remote work environments, upholding patient privacy and HIPAA compliance.

Communication for a Coordinated Response

During disasters like the California wildfires, communication is not merely a business function—it’s a lifeline. For specialty pharmacy patients, the uncertainty of a disaster can exacerbate anxiety, and reassurance becomes a form of care.

That’s why CSP employs a multi-channel patient communication strategy with a dedicated hotline operated by pharmacists trained to handle emergency refills, alternative delivery options, and clinical questions. To disseminate critical announcements and real-time updates such as closures and openings, CSP uses its website and social media posts.

Also key to managing a crisis response are communication and coordination among internal departments, external partners, and public agencies.

When we faced the wildfires, CSP:

• Activated our Emergency Operations Center (EOC), allowing leadership and key team members to centralize decision-making and disseminate information in real time.
• Established preferred communication channels with prescribing providers, and practices.
• Notified prescribers and healthcare providers about potential delays and collaborated on alternate therapy options when needed.
• Provided team members with a contact list of emergency responders, physicians, nurses, pharmacists, and other staff members to expedite communication and coordination.

Continuous Improvement

Finally, no disaster plan is ever “complete” or set in stone. After a crisis, there will almost certainly be opportunities for improvement. Facing a natural disaster in real-time can verify the effectiveness of your plan and identify potentially erroneous assumptions, knowledge gaps, and room for improvement. CSP’s team learned from its experience with the wildfires that it must cross-train more staff to fill multiple roles during a staff shortage and expand its courier network to include more regional providers.

The wildfires in California provided a sobering yet powerful example of the importance of disaster preparedness for emergency responses, recovery efforts, and business continuity. Through strategic planning, coordinated execution, and compassionate communication, CSP was able to uphold its commitment to patients, providers, and the community.