Pharmacists Asks CMS To Request Fee For Dispensing COVID-19 Pills

Medicare Part D plans should be required to pay pharmacists for patient counseling and dispensing of oral antiviral drugs that treat COVID-19, organizations representing pharmacists say.

Several promising treatments for COVID-19 have emerged in recent weeks, led by Merck, which an FDA advisory group recommended approval for emergency use on Tuesday. But while the Department of Health and Human Services authorized pharmacists will prescribe covered drugs for COVID-19 in September, Medicare and Medicaid Services did not require plans to pay pharmacists to dispense drugs.

Merck and Pfizer have developed pills to treat COVID-19 in high-risk patients. Both companies have applied to the FDA for an emergency use authorization. If the FDA grants emergency approvals for these drugs during the standard approval process, the federal government will cover the cost of the drugs.

But there is still no payment mechanism to allow pharmacists who are not Medicare providers to be reimbursed for patient screening or prescriptions, said Tom Kraus, vice president of government affairs for the American Society of Healthcare Pharmacists.

Last Tuesday, CMS issued guidance authorizing and encouraging Part D plans to pay pharmacies’ vacation cost claims without cost-sharing with beneficiaries, saying it could help make these drugs more affordable. Part D plans should consider paying higher vacation pay than normally negotiated rates, given the public health emergency surrounding COVID-19 and allowing out-of-network pharmacies to bill drugs, says manual.

There may be legal obstacles for the CMS to take a tougher stance on reimbursement of dispensing costs. Part D covers FDA-approved drugs, and even if Merck and Pfizer’s oral antivirals are approved for emergency treatment, it will take at least a few months to get full approval.

However, six pharmacy groups, including the American Society of Health Systems Pharmacists and the American Pharmacists Association, want CMS to require pharmacists to be paid for their work, especially since pharmacies are often the most convenient place for patients to receive medical services. According to the National Association of Pharmacy Chains, about 90% of Americans live within five miles of a pharmacy.

“After more than a year of continually empowering patients to access COVID-19 tests, immunizations and therapies from pharmacists and other pharmacy staff, CMS’s inability to demand compensation from pharmacists for testing, patient assessment and ordering / prescribing, in addition to dispensing oral antiviral drugs does not make much sense and sets up a distribution program in case of failure. CMS needs to clearly define the payment path necessary for patients of pharmacists to have access to these life-saving drugs, “- said in the message news release a group of pharmacists released Tuesday.

Pharmacists may be eligible for Medicare Part B reimbursement for injectable monoclonal therapy as CMS has authorized them to be treated as vaccines under payment rules. But the agency cannot use this workaround for Part D oral therapy, Kraus said.

“HHS empowered pharmacists to do this job, assess and order the drug. But there was no appropriate decision from CMS to figure out how we pay for services when a Medicare recipient needs them, ”Kraus said.

CMS could use its emergency powers to override Social Security Act provisions and allow pharmacists to receive Medicare compensation for evaluating patients before giving them pills, Kraus said. The American Society of Health Systems Pharmacists, the American Pharmacists Association, and other organizations have recommended that CMS do this in letter posted to HHS on Nov 2.

“Other payers are watching Medicare, so we are concerned that if this happens to other payers, then the question is: Can pharmacists actually provide this service if it is not reimbursed for it?” said Kraus.

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