Pharmacy Organizations Criticize CMS COVID-19 Decision

CMS is not requiring payment for pharmacists’ testing, patient assessment, ordering/prescribing and dispensing for oral COVID-19 antiviral drugs.

A group of six pharmacy organizations criticized the CMS decision to “encourage” but not require payment to pharmacists in relation to oral COVID-19 antiviral drugs.

The issue is particularly time-sensitive as the FDA’s Antimicrobial Drugs Advisory Committee voted 13 to 10 to support emergency authorization of Merck/Ridgeback’s oral anti-viral molnupiravir to treat mild-to-moderate COVID-19 in adults.

In its guidance document, CMS said it is encouraging but not requiring payment for pharmacists’ testing, patient assessment, ordering/prescribing and dispensing for oral COVID-19 antiviral drugs.

The decision potentially limits the ability of Medicare patients “to access these lifesaving medications, particularly those in rural and underserved communities,” the groups said in a press release.

The six groups include: American Pharmacists Association, American Society of Consultant Pharmacists, American Society of Health-System Pharmacists, College of Psychiatric and Neurologic Pharmacists, National Alliance of State Pharmacy Associations, and the National Community Pharmacists Association.

“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 said.

“The federal government has made it clear we need all-hands-on-deck to defeat COVID-19 and advance health equity by authorizing pharmacists and other pharmacy personnel to order and administer oral antivirals,” they added.

While certain U.S. government-procured oral antiviral drugs will be made available at no cost to pharmacies, the procurement does not include payment of a dispensing fee to pharmacies, CMS said. “Part D sponsors may pay a dispensing fee to pharmacies that submit claims for these drugs. No ingredient cost can be paid on such claims,” the agency said.

While pharmacists are already billing the medical benefit and being reimbursed for administration of vaccines and monoclonal antibodies, they are not able to be paid for patient assessment services, the groups said in a November 2 letter to the Department of Health and Human Services.

“Clinical evaluation to determine a patient’s need of monoclonal antibodies and oral antiviral treatments, whether or not a medication is dispensed, should also be a reimbursable service by a pharmacist through the medical benefit,” they wrote.