Alexandria, VA—New oral antiviral medications might be game-changers against COVID-19, but distribution is likely to be affected if pharmacists continue to lose money dispensing them.
That's according to the National Community Pharmacists Association (NCPA), which blames "stingy fees paid by health insurance companies so far" in a letter to Centers for Medicare and Medicaid Services (CMS) administrator Chiquita Brooks-LaSure.
"While the reimbursement rates that NCPA members have reported may be higher than the usual negotiated dispensing fees, they are still far below these pharmacies' cost to dispense," the NCPA writes. "As of January 14, 2022, the highest enhanced dispensing fee reported is $10.50 with the low end being $1 by BlueCross Blue Shield's PBM Prime Therapeutics. These fees are lower than the Professional Dispensing Fee in most state Medicaid programs. Even the $10.50 dispensing fee fails to cover the additional costs required to optimize beneficiary safety and effectiveness for these breakthrough treatments. This is astounding and extremely disappointing considering the U.S. government has paid over $700 per course of therapy for molnupiravir and over $500 per course of therapy for PAXLOVID."
On December 23, 2021, the FDA granted Emergency Use Authorization to Pfizer for its oral antiviral drug, Paxlovid, and to Merck for its oral antiviral drug molnupiravir—both to treat COVID-19.
"NCPA asks for immediate intervention before these pharmacies are forced to stop dispensing the oral antiviral drugs because they can't justify the cost to their business," wrote NCPA Chief Executive Officer B. Douglas Hoey.
"The pharmacies in the first distribution cycle estimate the additional time involved with dispensing the oral antivirals requires a dispensing fee consistent with the COVID-19 vaccine administration fee of $40," Mr. Hoey explained. "This reflects additional steps such as the non-standard ordering and receiving of the physical product, on-boarding new patients, and participating in the prescriber decision-making process (working with prescribers to prioritize limited available doses, accurate data on e-prescriptions, transitioning patients from monoclonal antibodies to oral therapy)."
The letter goes on to say that "...it is unconscionable that Medicare Part D plan sponsors and/or their pharmacy benefit managers (PBMs) are reimbursing pharmacies at these dismal rates, especially when these therapies can avoid costly hospitalizations. NCPA is asking for immediate intervention to ensure continued access to oral antivirals for COVID-19, and that CMS use your full authority to provide Medicare and Medicaid coverage of the additional pharmacists' costs to dispense these vital therapies."
In late November, the NCPA joined with five other groups—the American Pharmacists Association, the American Society of Consultant Pharmacists, the American Society of Health-System Pharmacists, the College of Psychiatric and Neurologic Pharmacists, and the National Alliance of State Pharmacy Associations to criticize a CMS decision to "encourage" but not require payment to pharmacists for testing, patient assessment, ordering/prescribing, and dispensing for oral COVID-19 antiviral drugs. The associations warned this would potentially limit the ability of Medicare patients to access the lifesaving medications, especially if they live in rural and underserved communities.
The groups state in a press release, "After more than a year of continuously expanding the ability of patients to access COVID-19 tests, immunizations, and therapeutics from pharmacists and other pharmacy personnel, the failure of CMS to require pharmacists to be compensated for testing, patient assessment, and ordering/prescribing, in addition to dispensing oral antivirals makes little sense and sets up the distribution program for failure," the groups wrote, adding, "CMS needs to clearly delineate a payment pathway necessary to allow pharmacists' patients to access these life-saving medications. With 90 percent of Americans living within five miles of a pharmacy, making them the most viable access point for patients to receive these medications. In addition, the neighborhood pharmacy in rural and underserved communities may be the only health care provider for miles."
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