Best Practices for Community Pharmacy During the COVID-19 Response
Updated: Jan 12
With the COVID-19 vaccine rolling out, the demand for pharmacists is back on the rise. Several studies suggest that it could take 7 weeks longer to vaccinate 80% of adults during a pandemic if community pharmacies are not included, highlighting the critical role of pharmacists during the COVID-19 crisis. This is an ideal time to share your value in the healthcare industry, serve your communities when they need it the most, and push for much needed progress in your profession.
What does my pharmacy need to do to get involved?
On September 3, 2020, under the Public Readiness and Emergency Preparedness Act, the U.S. Department of Health and Human Services approved administration of COVID-19 vaccines by state-licensed pharmacists as well as state-authorized pharmacy interns and qualified pharmacy technicians under supervision of a qualified pharmacist. To be part of this, vaccinators must meet specific education requirements. These include completion of an ACPE-approved practical training program that includes hands-on injection technique; clinical evaluation of indications and contraindications of vaccines; and recognition and treatment of emergency reactions to vaccines with at least 20 hours of this training for the pharmacist. In addition, all vaccinators must have a current certificate in basic cardiopulmonary resuscitation and pharmacists and technicians must complete at least 2 hours of ACPE-approved, immunization-related continuing pharmacy education during each state licensing period. To participate in the COVID-19 vaccine effort, you must register at www.vaccinefinder.org. It’s mandatory, so do this first. Then get online and verify that the National Council for Prescription Drug Programs pharmacy profile shows you offer immunizations. If you haven’t offered other vaccines, enroll as a pharmacy provider with Medicare to ensure payment for the immunization service. (The vaccines will be free to pharmacies and patients.)
The immunization campaign against COVID-19 may be the largest public health effort any of us will see in our lifetime, so stay in touch with your state pharmacy association and local public health officials to ensure you receive all relevant updates. Your wholesaler and pharmacy system providers should also have information about changes you may need to make to serve as a COVID-19 vaccination site.
How do I make sure my pharmacy is prepared?
As you have probably heard, the vaccines need to be kept cold or frozen if held for any length of time. Because of this, it’s a good idea to assess your capacity for proper cold storage and temperature monitoring of the vaccines. If you have not done so already, identify a backup location for storage should your unit fail.
Check your tracking and reporting systems. You’ll need to report immunization data within 24 hours to your state registry or tap into an alternative reporting mechanism through the CDC. Make sure your systems are up to the task. At the same time, check that your systems can schedule appointments, identify which customers fall into priority groups for immunization, and track who has received which vaccine so that they come back for the proper second dose. While some of these capabilities have not yet been mandated, it is expected that they will be required.
What about Billing and Reimbursement?
COVID has brought new opportunities and has more pharmacies interested in services that can be billed and paid for outside the PBM, from the medical benefit. COVID Vaccines are within this category. Pharmacists may need a Type 1 NPI number to submit on claims where they are ordering/prescribing the vaccine. You can apply for, or lookup, an NPI number at: www.npiregistry.cms.hhs.gov. Pharmacists should also be certain they meet requirements from the board of pharmacy for a pharmacy-based immunization program.
For Medicare – The COVID-19 vaccine will be covered under the Part B benefit. Pharmacies can enroll in Medicare as a Pharmacy or as a Mass Immunizer online via the Provider Enrollment, Chain, and Ownership System (PECOS) website or using the CMS-855b form. Enrollment fees are waived during the COVID-19 Public Health Emergency.
Pharmacies that are already enrolled in Medicare as a DMEPOS Supplier or Independent Clinical Laboratory, need to enroll as a Pharmacy or Mass Immunizer to obtain a new Provider Transaction Access Number (PTAN) for vaccine claims. Both supplier types, Pharmacy and Mass Immunizer, are able to submit claims for administering COVID-19 vaccine.
Medicare payment rates for COVID-19 vaccine administration will be $28.39 to administer single-dose vaccines. For a COVID-19 vaccine requiring a series of 2 or more doses, the initial dose(s) administration payment rate will be $16.94, and $28.39 for the administration of the final dose in the series.
For Medicaid – State Medicaid programs have significant discretion in determining vaccine administration reimbursement rates but all must provide coverage for vaccine administration except to those with narrow range of benefit that does not ordinarily include vaccine coverage. States may elect to include vaccine administration coverage in their managed care plan contracts. Pharmacies should become familiar with vaccine administration coverage details for each state Medicaid program their patients have.
For Commercial – Health plans are required to reimburse in-network and out-of-network vaccine providers for administering the COVID-19 vaccine. Health plans may cover this service on the medical benefit, the prescription drug benefit, or both. Pharmacies should consider workflow, transaction fees, reimbursement rates and timing of remittance when given the option of medical billing or PBM billing.
For the Uninsured – The COVID-19 vaccine administration, as well as conducting COVID-19 testing, will be covered for the uninsured through the CARES Act (P.L. 116-136). The U.S. Department of Health and Human Services (HHS) will provide reimbursement for these services generally at Medicare rates, subject to available funding through the CARES Act. Pharmacies must enroll as a provider participant, check patient eligibility, submit patient information, and submit the claim in order to receive payment via direct deposit.
The National Community Pharmacists Association (NCPA) and the American Pharmacists Association (APhA) have prepared a number of valuable resources for pharmacists related to offering the new vaccines. To stay up to date on information regarding preparedness, approved CPE’s and billing, visit www.pharmacist.com or www.ncpa.org.