IDPH Launches SNF/LTC Request Form for COVID-19 Therapeutics

Recently, bamlanvimab and casirivimab/imdevimab were granted emergency use authorization for the treatment of mild to moderate COVID-19. Until the national supply of these medications is sufficient, the Iowa Department of Public Health and the United States government will be involved in allocation across Iowa. Medications are allocated on a weekly basis by the Iowa Department of Public Health, and AmerisourceBergen is responsible for distribution and shipment. Currently, allocation of casirivimab/imdevimab is limited to hospitals only but is expected to be made available to other types of facilities like SNF/LTC in the near future.

The intent of this form is to indicate a request for therapeutics and gather information on your LTC facility's capacity to administer medications and pharmacy structure. Submission of this form does not guarantee provision of therapeutics.

Prior to completing this form, please review:

• Operation Warp Speed Monoclonal Antibody Playbook
• Bamlanivimab Letter of Authorization (EUA)
• Bamlanivimab Provider Fact Sheet
• Casirivimab/imdevimab Letter of Authorization (EUA)
• Casirivimab/imdevimab Provider Fact Sheet

For questions, please contact Cassie Kennedy at [email protected] or (515) 330-5755. Please complete the form by Friday, December 18.  Note that you will need your pharmacy’s state license number and need to disclose your current readiness in a number of categories for protocols related to the therapy administration.