National Community Pharmacists Association to Centers for Medicare and Medicaid Services: Insurance Plans Shortchanging Public on New COVID-19 Antivirals

ALEXANDRIA, Virginia, Jan. 19 (TNSPol) -- The National Community Pharmacists Association issued the following news release on Jan. 18, 2022:

Community pharmacists on the front lines of the omicron surge are being forced to lose money to dispense new oral antiviral medicines based on the stingy fees paid by health insurance companies so far, said the National Community Pharmacists Association today in a letter to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure.

"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 CEO B. Douglas Hoey.

According to Hoey, the fees paid to pharmacies to date range from $10.50 on the high end, still far below the pharmacists' cost of dispensing, all the way down to $1. That's what Blue Cross Blue Shield's Prime Therapeutics thinks pharmacies should be paid for a process that takes nearly one hour and includes dozens of additional procedures and considerations.

"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. 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)," explained Hoey.

He told Brooks-LaSure, "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."

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To: The Honorable Chiquita Brooks-LaSure, Administrator, Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244

Re: Intervention needed for antiviral dispensing program viability

Dear Administrator Brooks-LaSure:

The National Community Pharmacists Association (NCPA) is imploring that the Centers for Medicare and Medicaid Services (CMS) immediately intervene to ensure robust access and appropriate use of COVID-19 oral antiviral therapies.

NCPA represents America's community pharmacists, including 19,400 independent community pharmacies. Almost half of all community pharmacies provide long-term care services and play a critical role in ensuring patients have immediate access to medications in both community and long-term care (LTC) settings. Together, our members represent a $67 billion healthcare marketplace, employ 215,000 individuals, and provide an expanding set of healthcare services to millions of patients every day. Our members are small business owners who are among America's most accessible healthcare providers.

Community pharmacies are on the front line of helping Americans prevent SARS-CoV-2 infections by administering hundreds of millions of vaccines and preventing hospitalizations by administering and dispensing COVID-19 therapeutics. States are relying on pharmacies to extend the access to therapeutics in rural areas and areas with high social vulnerability.

Now, at the end of just the first distribution cycle, pharmacy owners that are going above and beyond during this eye-popping surge of Omicron variant find themselves blinking in disbelief at the dispensing fees that are supposed to cover the costs involved in dispensing U.S. government procured PAXLOVID and molnupiravir. 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.

CMS urged Medicare Part D plan sponsors to pay "dispensing fees for USG-procured EUA oral antiviral drugs during the COVID-19 PHE sufficient to ensure eligible patients can readily access these drugs at available pharmacies. CMS encourages sponsors to consider paying a dispensing fee for these drugs that may be higher than a sponsor's usual negotiated dispensing fees given the unique circumstances during the PHE."

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. 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.

NCPA has spoken with numerous independent pharmacists who have been allocated product and are actively dispensing these prescriptions. The attached list is of additional tasks involved with dispensing oral COVID-19 antivirals that would not be considered part of the usual dispensing process - including a time factor for each. 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. 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).

Administrator Brooks-LaSure, 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.

Sincerely,

B. Douglas Hoey, R.Ph., M.B.A., NCPA Chief Executive Officer

The full letter can be viewed at: https://ncpa.org/sites/default/files/2022-01/1.18.2022-NCPAtoCMSPartDOralAntiviralDrugMedicarePayment.pdf