With the end of the Public Health Emergency (PHE) coming soon, you might be wondering what all that means. What does it mean for reimbursements? What will change? What won’t change? How will it potentially impact pharmacies? What will it mean for patients? Unfortunately, we don’t have all the answers yet. However, we will share what we do know to shed a little light on the end of PHE and what pharmacies can expect.
On January 30 of this year, the Biden administration announced that the COVID-19 Public Health Emergency, which has been in place since 2020, was set to end on May 11. This provided the healthcare system with just over 100 days notice to ensure continuity of care and a smooth transition. So, what does the end of the PHE mean? It likely means that changes are coming to the reimbursement of vaccines and COVID-19 medications as coverage shifts from the government to private individual and group insurance. COVID-19 vaccines are expected to be covered by most insurance companies, while tests and treatments, depending on the plan, will likely be available via patient cost sharing. We won’t experience these changes until January 1, 2024, per the PHE provisions. For Medicaid patients, COVID-19 testing, vaccines, and treatments will be covered for a year after the end of PHE.
However, for pharmacies there’s a bit of a silver lining, not all COVID-19 authorities are tied to the end of the PHE. Authorities provided under the Public Readiness and Emergency Preparedness (PREP) Act, including pharmacist vaccination, testing, and treatment, do not expire until October 1, 2024.
What can pharmacies do to prepare? Here are two recommendations:
1. Keep doing what you’re doing. Pharmacies rose to the challenge during the pandemic and have proven themselves as care providers that can test and treat effectively. According to an APhA study, pharmacists successfully delivered over 170 million COVID-19 vaccinations and sat up testing and treating centers where they administered 42 million COVID-19 tests and 100,000 monoclonal antibody treatments. Additionally, pharmacists and their staff provided more than 350 million clinical interventions to more than 150 million people in the form of testing, antibodies, vaccinations, antiviral therapies, and etc. Pharmacies should continue to take advantage of all the testing opportunities available such as those for strep, flu, and pneumococcal. Plus, they should continue providing much-needed vaccinations for the communities they serve such as those for shingles, pneumococcal, flu, and etc.
2. Stay focused on serving your community. Even more important, is the health of patients, especially those that might not have access to affordable care. Pharmacies are well positioned to serve patients who may live in rural or highly populated areas where they simply don’t have access to a provider. The pharmacy’s close proximity to most patients in America provides that access to care. In addition, provider office visit fees and other expenses put healthcare out of reach for many people. Simply put, the pharmacy provides a more affordable option. During the pandemic, pharmacy has proven again and again that it is the most assessable and affordable option in areas where it’s more difficult to get care.
- 70% of vaccinating pharmacies are located in communities with moderate-to-high social vulnerability
- Pharmacy teams made significant strides to improving equity in vaccine distribution, by vaccinating a disproportionately greater share of non-Hispanic Asian and Hispanic or Latino persons
- Pharmacy teams filled a major gap in vaccinating their neighbors against the flu and other vaccine-preventable diseases
3. Get involved in federal and state legislative activities. Riding the success of pharmacies during the pandemic, now is the time to advocate for continued provider-like status. It’s possible that the PREP Act could be extended at the federal level. In fact, HHS just announced plans to extend the PREP Act through Dec. 2024. The ECAPS Act which has stalled in the House of Representatives could be revived. And finally state laws can be created or amended to keep these provider-like privileges in place. Call or email your state/federal representatives and get involved with pharmacy associations to take action in helping to secure your ability to keep serving patients and improving the health of your community.
To help you get started, we’ve compiled a few helpful resources:
American Pharmacists Association (APhA)
National Alliance of State Pharmacy Associations
National Association of Chain Drug Stores
National Community Pharmacists Association (NCPA)
State Legislative Activity
NASPA 2022 Provider Status End-of-Year Legislative Update
The PHE is ending soon and now is the time for pharmacies to take action as they continue to serve COVID-19 patients under the PREP Act, take advantage of all the testing and vaccination opportunities available, and contribute to legislative efforts to continue the provider-like privileges they have become accustomed to during the pandemic. By taking these actions, pharmacies can continue making a positive impact to improve the health of communities around them while growing a thriving pharmacy business.