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Lack Of Reimbursement Forces Colorado Pharmacy To Not Offer Antiviral COVID Pill Paxlovid

LONGMONT, Colo. (CBS4) - A new antiviral pill for treating COVID-19 could play a key part in moving past the pandemic, but some pharmacists won't carry it. That's because some are getting paid as little as $1 to give it out.

"It's not the best feeling, but sometimes as a business owner you have to make hard decisions," said Jennifer Palazzolo, owner of the pharmacy.

Between vaccines and COVID-19 testing, Flatirons Family Pharmacy in Longmont has been there every step of the pandemic, but lately, there's one thing they won't do.

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While oral antiviral COVID treatments, such as Paxlovid, have been available for weeks now, Palazzolo says she won't carry them.

"They're basically saying, 'Here, do this for free,' not taking into account the cost of somebody typing it, the cost of a pharmacist checking it, the cost of the label," she said.

Palazzolo is concerned about reimbursement or dispensing fees, which cover the cost of her staff and services. Currently the fees are as little as $1 and as high as $10, she said.

For the COVID-19 vaccine, the Medicare reimbursement rate is currently $40, according to the Centers for Medicare and Medicaid Services. Palazzolo said a fee of $20 would be enough for her to start dispensing the oral antibody treatments.

"What is being reimbursed is not worth the risk to my staff," Palazzolo said. "Putting them at risk and your business at risk by someone possibly getting it and saying that is worth pennies is insulting."

"This isn't about making huge amounts of money," said Emily Zadvorny, Executive Director of the Colorado Pharmacists Society.

According to Zadvorny, the issue begins with Pharmacy Benefit Managers (PBMs), who are the third-party middlemen between pharmacies and insurance plans. Right now, the government is encouraging PBMs to pay the fees, but not requiring it.

In January, the American Pharmacists Association (APhA) urged plans, PBMs, and CMS take immediate action to provide "adequate and appropriate pharmacists' payment" for dispensing COVID-19 oral antivirals.

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Several days later, JC Scott, the President & CEO of the Pharmaceutical Care Management Association (PCMA), which represents pharmacy benefit managers, said PBMs are "voluntarily paying dispensing fees for these drugs, which are not technically covered by Medicare and other insurance."

"What would be helpful, is yes, a federal mandate to set prices just like they did for vaccines," Zadvorny said.

If not, she says more pharmacies will choose not to dispense and administer the drug, which could affect patients. While it's unclear how many Colorado pharmacies are choosing that option, Zadvorny said she knows independent pharmacies are struggling with the predicament the most.

"Ultimately patients could end up extremely frustrated or miss the window for being able to access what they need," she said. "That's very scary because as we know, these drugs are meant to take a mild case and prevent it from becoming severe."

Palazzolo says it's a difficult decision, but what's best for her staff and business at this time.

She's hoping the circumstances change soon.

"My hope is because this is affecting access to a drug that can help during a public health crisis, maybe more politicians will open their eyes to exactly what's going on."

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