COVID-19 Pandemic Presents New Reimbursement Challenges

Pharmacy Times spoke with Crystal Lennartz, PharmD, vice president of pharmacy performance at McKesson, about how reimbursement issues have been affected by the coronavirus disease 2019 (COVID-19) pandemic.

Pharmacies are continuing to feel pressure from declining reimbursement rates, Lennartz said. Eliminating direct and indirect remuneration fees is one of the most important reimbursement concerns for pharmacies, especially as they have drastically increased over the previous decade.

As many patients tried to limit trips to the pharmacy during the COVID-19 pandemic, an increase in 90-day prescriptions presented new challenges for pharmacies. Lennartz said these prescriptions can often result in underwater reimbursements, in which the pharmacy actually loses money. Fewer interactions with the pharmacy team can also present challenges, as they are less able to monitor patients’ adherence or other concerns.

Finally, Lennartz said it’s important that pharmacists are properly reimbursed for the administration of many common immunizations, including the flu vaccine. Despite reimbursements for many common vaccines, some vaccines are not included under pharmacy benefit managers’ vaccine administration networks, meaning pharmacies are not always reimbursed. Many questions still remain about the administration and reimbursement for any upcoming COVID-19 vaccines, Lennartz said, but she added that regardless, pharmacies should be properly reimbursed.