Illustration: Sarah Grillo/Axios
Pharmacies that say they've been a linchpin in the U.S. pandemic response are pressing for key regulatory changes and higher payment rates to cement their enhanced role in patient care.
Why it matters: Pharmacies have become fixtures of pandemic life through testing, vaccinations and, increasingly, dispensing antivirals. But pharmacists say they're being shortchanged, because they can't prescribe COVID pills and receive prohibitively low fees to dispense them.
Driving the news: The Biden administration's test-to-treat initiative, which began this week, has ignited a fierce debate over what pharmacists can and cannot do.
- The initiative allows patients to get tested for COVID in a pharmacy and be prescribed antivirals at the same location if they're found to be positive. But only pharmacies with qualified providers — like those with on-site clinics — can participate, under the FDA authorization for both Merck and Pfizer's COVID antivirals.
- Pharmacists are pushing for the FDA exclusion to be lifted so that they can take part in the effort, which they say will ultimately expand access to the antivirals.
- Under current policy, "Americans who test positive at a pharmacy will only be able to access time-sensitive oral antivirals, on the spot, from a limited number of pharmacies with in-house access to non-pharmacist prescribers, primarily in metropolitan areas," a group of pharmacy associations wrote yesterday in a letter to the administration.
The big picture: The push isn't the first time during the pandemic that pharmacists have argued they are well-qualified for a more active role in patient care.
- They say that certain emergency powers the government granted on a temporary basis has provided the opportunity to shine.
- "We've proven our worth during the pandemic, and we need a federal law that allows us to do what we've already been doing — to test and treat patients," said Scott Knoer, CEO of the American Pharmacists Association.
Between the lines: Broadening pharmacists' formal role in patient care could open the door to them getting paid more.
- For example, pharmacists are currently only paid a dispensing fee for the antivirals by pharmacy benefit managers, which many have argued is prohibitively low. Other providers — like physician assistants and nurse practitioners — can bill for professional fees.
- But even if pharmacists are allowed to order the pills for patients, there's no clear mechanism under current law for them to get paid the way other providers are, pharmacists say.
- "We need to have a professional fee," Knoer said. "Folks that would want to do antivirals on a large scale, if there wasn't reimbursement for it, that wouldn't be long-term viable."
The other side: The American Medical Association has argued that expanding prescribing authority is dangerous.
- "Leaving prescribing decisions this complex in the hands of people without knowledge of a patient's medical history is dangerous in practice and precedent," the organization recently said in a statement.
What we're watching: The pharmacists are set to lose their enhanced role when the public health emergency expires, setting up a test of how policymakers will approach a post-pandemic future.
- Without any changes, pharmacies worry that they won't have federal authority to administer tests and vaccines, though state policy varies.
- Nor will there be a clear payment mechanism for them to be reimbursed for these services.
- "If we don't have payment reform, pharmacy isn't going to be around like we were for the next pandemic," Knoer said.
Editor's note: This story originally published on March 10.