Pfizer Pill Prescribing Power Spurs Pharmacist Calls to Medicare

The FDA’s decision to let pharmacists prescribe Pfizer Inc.’s Paxlovid could be a game-changer in expanding Covid-19 treatment access—but only if pharmacies are adequately paid for their work, trade groups say.

The Food and Drug Administration announced this week that state-licensed pharmacists can prescribe Pfizer’s Covid pill to eligible patients, with certain limitations. The move prompted praise from pharmacists across the US who for months have called for prescribing rule changes to ease access in minority and rural communities, which often rely on independent pharmacists as their main source of care.

But pharmacies say they would be better equipped to handle this new responsibility if the Medicare agency required health plans to pay them for assessing patients and conducting other work needed to dispense the pill.

Some health plans have been doling out as little as $1, the groups say.

“If pharmacies are just paid dispensing fees like they have been, then nothing’s going to get better,” Kurt Proctor, senior vice president of strategic initiatives at the National Community Pharmacists Association, said.

“Hopefully, the other branches of the government will follow on behind this FDA action and describe how they’re going to pay pharmacists for this activity, and that it will be fair and equitable,” said Proctor, whose organization represents more than 19,000 independent pharmacies across the US.

A spokesperson for the Centers for Medicare & Medicaid Services said in an email that the agency has encouraged health plans to pay an appropriate dispensing fee for these drugs, and urges Medicare Part D plans to make sure eligible patients can easily access the treatment if they need it.

The spokesperson added that the agency may update its guidance for Part D plan sponsors in the future.

The FDA said July 6 that patients seeking Paxlovid should bring a complete list of medications so the pharmacist can review potential drug interactions, as well as a blood test result from within the last 12 months. Pharmacists should refer patients to a physician or other primary care provider if the patient’s existing medication list needs to be changed or if there are questions about their kidney or liver function, the agency said.

“Since Paxlovid must be taken within five days after symptoms begin, authorizing state-licensed pharmacists to prescribe Paxlovid could expand access to timely treatment for some patients who are eligible to receive this drug for the treatment of COVID-19,” Patrizia Cavazzoni, director of the FDA’s Center for Drug Evaluation and Research, said in a statement.

Improving Equity

Pharmacists say allowing them to prescribe will alleviate some barriers that have so far limited the reach of the Biden administration’s Covid treatment initiatives.

President Joe Biden unveiled earlier this year his Test to Treat initiative, which now has thousands of locations across the country where patients can immediately receive an authorized antiviral pill from Pfizer or Merck & Co. if they test positive.

These sites have been set up at pharmacy-based clinics, community health centers, and other facilities that have in-house physicians or other authorized prescribers. Pharmacy groups say minority and rural communities typically have had difficulty accessing these sites, further exacerbating health inequities made worse by the Covid-19 pandemic.

“Opening the door for pharmacists as prescribers will open the door to equitable access at pharmacies in communities across the country,” said Ilisa Bernstein, interim executive vice president and CEO of the American Pharmacists Association.

Tom Kraus, vice president of government relations for the American Society of Health-System Pharmacists, said the group was “pleased to see the FDA remove this barrier to patients’ access to this critical treatment.”

“Pharmacists have played a vital role in our pandemic response efforts and are well-positioned to help patients, particularly those in rural and underserved communities, benefit from this medication,” he added.

Medicare Action

Demands for pharmacists to be eligible to prescribe increased after high-risk Americans reported having a tough time getting Covid-19 antiviral pills while prescribers grappled with limited guidance.

Pharmacists say the change will have a better chance at successfully improving health equity if health plans adequately reimburse them.

Right now, it can take up to 30 minutes for a pharmacist to assess a patient to determine if Paxlovid is right for them, and also identify any drug-drug interactions, Bernstein said.

“It is important for CMS and other payers to develop payment pathways to reimburse pharmacists for their services related to assessing the patient and prescribing the drug, just like any other prescriber is paid,” she said.

The CMS said in November 2021 guidance that while certain antiviral drugs would initially be available at no cost to pharmacies, typical dispensing fees wouldn’t automatically covered. The agency said it “strongly encourages” sponsors of Medicare Part D prescription drug plans to pay those fees, but didn’t suggest an amount.

The NCPA said in a January letter to the CMS that health insurance plans were paying as high as $10.50 for the dispensing fee—an amount the group argued should be closer to the $40 Medicare requires for coverage of a single dose Covid-19 vaccine.

Pharmacists now looking to prescribe Paxlovid directly to patients will need to conduct even more work on top of the dispensing tasks to get Paxlovid to patients who need it, Proctor said.

“I would expect Medicare and CMS and other payers to pay for that professional service,” he added.

Congress

Congress should also join the push for adequate Medicare coverage of pharmacy services, the National Association of Chain Drug Stores said.

A bill in the House (H.R. 7213) by Rep. Ron Kind (D-Wis.) would provide Medicare Part B coverage for pharmacist services, including treatment for conditions like Covid-19. The measure was introduced in March and has yet to advance.

Steven C. Anderson, president and CEO of NACDS, said the FDA’s prescribing order change was “a crucial step forward” that should push others to act.

“We encourage the federal government to take the necessary next steps to support pharmacy-based assessments that guide the use of this lifesaving therapy,” he said.