Since the State of the Union address, test and treat has been getting a lot of attention. At OmniSYS, our position is clear, pharmacists are more than qualified to execute test and treat, both for COVID-19 and many other diseases, and the government must take the next steps to make this vision a reality. After the dust settled and pharmacists were not given prescriptive authority, we didn’t give up the fight.
And now, we see the result. The FDA officially announced prescriptive authority for pharmacists under specific protocols, for COVID-19.
Dr. David Pope, PharmD, CDE and OmniSYS EVP, Innovation and Industry Relations is staying on top of this moment in the press and on social media. We will be continually updating this post as additional details come to light.
LATEST TEST & TREAT UPDATES:
COVID-19 #testtotreat approval for pharmacy is here. This is a crucial first step in improving #healthcareequity as we continue to combat the #COVID19 pandemic. But there are several additional steps that must be taken to operationalize test and treat in the #pharmacy environment.
1. Centers for Medicare & Medicaid Services must recognize pharmacists as providers, triggering commercial payers to buy-in.
2. Pharmacies must work to get contracted with payers to ensure they are reimbursed for this vital clinical service.
3. Pharmacists must unite in their approach that this service fall under the medical benefit and not go through the PBMs.
We’re ready, so let’s do this!
Here’s the situation:
-Pharmacists can now prescribe Paxlovid as long as specific criteria is met.
-Pharmacists will need specific lab, medication history, and other data before prescribing, and will need to document it appropriately.
Here’s what we’re working on now:
-Payment: Pharmacists should be billing for office visit codes for evaluating the patient and, at times, prescribing. We’re working with Medicare/state Medicaid’s and public payers to define the pathway for reimbursement for services.
Today the FDA officially announced prescriptive authority for pharmacists for #COVID19 antiviral Paxlovid under specific protocols. Not only will this greatly improve access for these life-saving drugs, the potential impact on #healthcareequity is monumental.
What’s next? Centers for Medicare & Medicaid Services
and commercial payers must recognize provider status for pharmacists and adequately reimburse this vital clinical service.
Let’s do this!
“Anyone notice the AMA response to pharmacy #TestToTreat actually had nothing to do with #pharmacists having the ability to prescribe #COVID antivirals? Their response outlines concerns with directing patients to pharmacy-based clinics with an in-house practitioner. These clinics almost exclusively utilize a nurse practitioner, physician’s assistant or even a physician on site. So why is the AMA concerned with PA’s or NNP’s, who are typically overseen by a physician, just because they’re in a #pharmacy? Based on the reasoning detailed in the press release, the AMA should have included urgent care centers as an area of concern.
Make no mistake, #physicians should have a voice in public health issues and I truly care about what they collectively believe is the right path. I also believe in the good intent of the AMA. So if there are concerns about pharmacists prescribing COVID antivirals, let’s discuss the specifics. Healthy debate doesn’t degrade; instead, it brings the best solutions forward.
‘I never considered a difference of opinion in politics, religion, in philosophy, as cause for withdrawing from a friend.’
The nation’s top pharmacy organizations banded together to pen an open letter to President Biden regarding the scope of the test to treat program. Especially for underserved communities and those in healthcare deserts, expanding the scope of the test and treat program is vital to providing health equity.
“#TestandTreat is gaining steam! Virtually every national #pharmacy organization co-signed a letter to #potus encouraging the FDA to update their stance on oral antivirals. Widespread coordination of pharmacy groups on this subject. #letsdothis https://lnkd.in/dU5HkHv2
Well done Douglas Hoey Scott Knoer Chad Worz, PharmD, BCGP, FASCP”
Despite pushback from the AMA, the pharmacy industry is united: Pharmacists can, and should be given test and treat prescriptive authority.
NACDS recently issued this statement in response to AMA pushback.
“The effectiveness of COVID antivirals depends on patients’ receiving them shortly after the onset of symptoms. When it comes to the patient journey for these medications, access and equity are critically important, and pharmacy-based clinics, pharmacies and pharmacists have essential roles to play. “
“Here’s what we know so far:
1. To activate #pharmacists for #TesttoTreat, there are still a number of steps to be taken (see my previous post for more detail but in summary, the #FDA must update the antiviral #EUA‘s allow pharmacists to prescribe, and payers must allow pharmacists to be reimbursed as prescribers).
2. Behind the scenes, there’s pushback. Why? What happens when a patient with a positive test has a drug interaction? Some in the medical community, including in an article posted in the WSJ yesterday, are concerned the pharmacist would then arbitrarily suggest discontinuing interacting medications in order to take the antiviral.
The answer here is simple: Pharmacists are qualified to make basic medical necessity determinations based on the clearly defined protocols for the COVID-19 antivirals. If the medical decision making process becomes more complex, the pharmacist refers the patient to their PCP for follow up.
Pharmacists leveraging protocols for prescribing is already happening today. For example, in Idaho, pharmacists are prescribing a statin to diabetes patients through a protocol. In other words, this isn’t new. Pharmacists have the ability to know when to prescribe and when they need to refer the patient for more complex medical decision making.
The other key here is that pharmacists aren’t doing this on paper. Pharmacy technology helps in a big way, providing guardrails and referral capabilities when a pharmacist is not able to safely prescribe.
1. #FDA– update EUA’s to allow pharmacists the authority to prescribe.
2. #Medicare– Allow pharmacists the ability to be reimbursed for the encounter through the medical benefit. A positive test doesn’t necessarily mean Paxlovid should be administered. Therefore, pay #pharmacists for evaluating the patient and prescribing. This is significant as it will reimburse pharmacists as medical providers on the medical benefit (aka provider status).
3. #HRSA– Allow pharmacists to submit office visit codes when there isn’t coverage elsewhere.
Lets do this!”
Test and Treat: So What’s Next?
Right now, we wait. As we’ve mentioned, CMS must take the next steps for test and treat to become a reality in the pharmacy. Now that FDA approval is here, Medicare and HRSA take the reigns to outline how reimbursement will come to fruition. We’re paying close attention to all of the stakeholders with this initiative and will keep you informed as updates come along. When test and treat comes to life, CareCLAIM® and Strand-Rx® will be ready.
Test and Treat Pharmacy Resources
Looking for more test and treat resources? We hear you!
And back in December we held our first test and treat townhall where we answered all your questions about what we thought was coming quickly to the pharmacy industry.
What about Testing?
Don’t worry, we haven’t forgotten about testing! Check out our COVID-19 testing playbook to operationalize COVID testing in your pharmacy. The playbook, while specifically discussing COVID-19, can be adapted to fit most point-of-care tests you can administer with a CLIA waiver.
Test and Treat Summary
We don’t know how the next few days or weeks will play out. But we will stay on top of all of the news, and we’re not going to give up on test and treat for pharmacy.