ASHP Calls for Medicare and Medicaid Payment for Paxlovid Prescribing by Pharmacists

ASHP urged the Centers for Medicare & Medicaid Services (CMS) to clarify the regulatory and billing mechanisms that would allow pharmacists to be reimbursed for prescribing Paxlovid and performing the clinical services that are needed for safe use of the product.

"Given the current COVID-19 surge, and the Food and Drug Administration’s recent authorization of pharmacists as prescribers of Paxlovid, it is critical that pharmacists are able to begin offering this service as soon as possible," said Tom Kraus, ASHP's vice president of government relations, in a July 21 letter to CMS Administrator Chiquita Brooks-LaSure.

"However, absent a reimbursement mechanism for clinical assessment and counseling of patients seeking the medication, this service may prove financially infeasible for many pharmacies and pharmacists, particularly those working in rural and underserved areas," Kraus stated.

In the letter, ASHP recommended that CMS issue guidance confirming that pharmacists are eligible to use standard evaluation and management billing codes when prescribing Paxlovid and providing related care. ASHP also urged CMS to use its emergency and demonstration project authorities to affirm pharmacists' eligibility to be reimbursed for Paxlovid-related services under Medicare and other federal health programs.

ASHP remains committed to ensuring that pharmacists have the ability to provide essential COVID-19 drug therapy and to removing barriers that adversely affect the pharmacist–patient relationship.