Health insurers and pharmacy benefit managers are paying pharmacists a penny to about $10 to fill prescriptions for COVID-19 treatment pills, The Wall Street Journal reports. Pharmacists are pushing back.
Although the government paid billions of dollars for Paxlovid from Pfizer and molnupiravir from Merck and Ridgeback Biotherapeutics, it left the details of how much pharmacists are reimbursed for filling prescriptions to health insurers and PBMs. The range of dispensing fees reported by WSJ — a penny to $10 per prescription — is based on pharmacy transaction records and pharmacists, many of whom say the fees don't cover the costs of filling prescriptions. Some pharmacists told WSJ they won't stock the pills with their current reimbursement rates.
Pharmacies are lobbying over the matter, pushing the government to intervene. The National Community Pharmacists Association trade group has urged CMS to recommend a fee similar to the $40 that Medicare pays pharmacies administering COVID-19 vaccines. CMS can't regulate dispensing fees for private health insurance, but the agency has encouraged insurers and PBMs "to consider paying an appropriate dispensing fee for these drugs," a CMS spokeswoman told WSJ.
The National Association of Chain Drug Stores also supports a CMS recommendation but isn't specifying an amount.
The dispensing fee is supposed to cover pharmacy services, staff and overhead. Pharmacists say Paxlovid and molnupiravir prescriptions typically take more than 30 minutes to fill, longer than other drugs, as well as extensive patient counseling.
Read the WSJ report in full here.