Doctors and pharmacists are at odds over a proposal that would temporarily allow pharmacists to be directly reimbursed by Medicare for administering COVID-19 tests and vaccines.
As lawmakers haggle over the next COVID-19 relief package, a brewing fight has emerged over pharmacists' role in response to the pandemic. Pharmacists are pushing to temporarily be given Medicare provider status so they can more easily be paid for administering COVID-19 tests and vaccines. But the powerful American Medical Association has reservations, and Senate aides said AMA has lobbied against allowing pharmacists Medicare provider status.
The draft proposal is being pushed by Rep. Buddy Carter (R-Ga.), a pharmacist, and has support from Senate Finance Chair Chuck Grassley (R-Iowa), who has supported changes to pharmacists' Medicare provider status for years.
"Patients need professionals practicing to the full extent that their state license allows, especially as we get closer to the start of the flu season, which will only compound the pressure the coronavirus is placing on the health care system," said Grassley spokesperson Michael Zona.
The National Association of Chain Drug Stores claimed that AMA is blocking the temporary provider status draft bill from becoming law.
"The AMA's lobbying is out of step with doctors who are excellent partners with pharmacies and pharmacists, and out of step with the fact that doctors and pharmacists are highly trusted healthcare professionals," National Association of Chain Drug Stores President and CEO Steven Anderson said in a written statement.
AMA said the legislative process is ongoing and it looks forward to reviewing final legislative text.
"Pharmacists' work has been – and will continue to be – critical to ending this pandemic," AMA said.
The Trump administration has created a clunky workaround so pharmacists can get paid for administering COVID-19 tests. CMS on May 8 created a pathway for pharmacists to register as clinical labs to get reimbursed by Medicare.
But pharmacists argue that the regulatory actions don't go far enough. Carter said that the CMS pathway allows some pharmacies to be paid for the cost of the test materials, but not for other services related to administering tests.
"It's not just the cost of the product. They need to be compensated for their professional services," Carter said.
Many pharmacies haven't taken advantage of the new CMS pathway. According to data compiled by the National Alliance of State Pharmacy Associations, 1,465 pharmacies have newly registered as clinical labs since the CMS guidance was issued. That makes a total of just over 14,000 registered pharmacies out of more than 62,000 total pharmacies in the U.S.
Ronna Hauser, vice president of policy and governmental affairs at the National Community Pharmacists Association, said pharmacies in some states have had issues registering for Medicare payment through CMS because they aren't able to get testing supplies, so they can't file an application specifying which tests they want approval to administer.
"CMS has told us repeatedly, they have done what they can do under statute," Hauser said.
HHS has also entered some public-private partnerships with large pharmacy chains to establish testing sites, but those deals only apply to around 20% of pharmacies, Carter said.
The draft bill Carter is currently considering is narrower than a version pharmacies pushed in earlier negotiations on the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Pharmacies narrowed their asks after feedback from AMA and technical assistance from CMS, and now feel a sense of urgency as this upcoming package may be the last major bill to pass before the 2020 election. Carter's current draft is time-limited to the public health emergency or the HHS secretary's discretion.
Beyond building much-needed testing capacity, pharmacists could also have an important role to play in administering an eventual COVID-19 vaccine. There simply aren't enough physicians to quickly vaccinate the entire country, said John O'Brien, a pharmacist and former HHS senior adviser to the secretary on drug pricing reform.
A Centers for Disease Control and Prevention study published in 2017 found that letting retail pharmacists administer a vaccine during an influenza pandemic increased weekly adult vaccination capacity by 10 million people, and shortened time to 80% vaccine coverage by seven weeks.
"Pharmacists are standing by and ready to help, and Medicare should pay pharmacists to administer a COVID vaccine like they already do flu and pneumonia vaccines," O'Brien said.
Carter is hopeful his proposal will be included in the next COVID-19 package. Senate Republicans' initial offer is set to be released early next week.
"I'm hopeful. I've been to the altar and been disappointed before, so I wouldn't say I'm optimistic. But I'm hopeful," Carter said.