Pharmacist asks CMS to charge COVID-19 pill dispensing fee


The organization representing pharmacists stated that the Medicare Part D plan should be required to pay pharmacists to provide consultations to patients and distribute oral antiviral drugs for the treatment of COVID-19.

Several promising treatments for COVID-19 have emerged in recent weeks, led by Merck Pharmaceuticals, an advisory group from the Food and Drug Administration Proposal for approval Emergency use on Tuesday.But although the Ministry of Health and Human Services Authorization The pharmacist administers the covered COVID-19 treatment in September, but the Medicare and Medicaid Services Center does not mandate that the health plan pay the pharmacist for the drug.

Merck and Pfizer have developed Pills for COVID-19 In high-risk patients. Both companies have applied for emergency use authorization from the FDA. If the FDA issues emergency authorization for these drugs while the standard approval process is in progress, the federal government will bear the cost of these drugs.

However, Tom Krauss, vice president of government relations for the American Association of Pharmacists of the Health System, said there is still no payment mechanism for pharmacists (not considered medical insurance providers) to obtain reimbursement to evaluate patients or fill out prescriptions.

Content management system release guide Last Tuesday allowed and encouraged Part D pharmacies that plan to pay for dispensing costs without the beneficiary’s share of the cost, and said this may help make these drugs more accessible. The guidance stated that given the COVID-19 public health emergency and allowing out-of-network pharmacies to charge for medicines, Part D plans should consider paying higher-than-usually negotiated dispensing fees.

There may be legal obstacles for CMS to take a tougher stance on reimbursement of dispensing costs. Part D covers FDA-approved drugs. Even if Merck and Pfizer’s oral antiviral drugs receive emergency authorization, it will take at least several months to obtain full approval.

Nonetheless, six pharmacy groups, including the American Association of Health System Pharmacists and the American Association of Pharmacists, hope that CMS will require pharmacists to pay for their labor, especially because pharmacies are usually the most convenient place for patients to obtain healthcare services. . According to the National Association of Chain Drug Stores, nearly 90% of Americans live within 5 miles of pharmacists.

“After more than a year of continuous expansion of patients’ ability to obtain COVID-19 testing, immunization and treatment from pharmacists and other pharmacists, CMS failed to require pharmacists to conduct testing, patient evaluation and order/prescription, except for the distribution of oral antibiotics. Viral medicines don’t make much sense and set up a failed distribution plan. CMS needs to clearly describe the necessary payment channels to allow pharmacists’ patients to obtain these life-saving medicines,” said a joint Press Releases The pharmacist group announced on Tuesday.

Pharmacists can be reimbursed under the injectable monoclonal therapy under Part B of the medical insurance because CMS allows them to be treated as vaccines under the payment rules. But the agency cannot use this workaround for oral therapy under Part D, Krauss said.

“HHS authorized pharmacists to do this work, to evaluate and order drugs. But CMS did not provide a solution to figure out how we would pay for services when medical insurance beneficiaries needed it,” Klaus said.

Krauss said that CMS can use its emergency powers to exempt the provisions of the Social Security Act and allow pharmacists to obtain medical insurance reimbursement before administering drugs to patients to evaluate patients.The American Association of Health System Pharmacists, the American Association of Pharmacists, and other organizations recommend that CMS letter Sent to HHS on November 2nd.

“Other payers follow Medicare, so we are worried that if this happens to other payers, then there will be a question: If there is no reimbursement, can the pharmacist actually provide this service?” Klaus said.



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