U.S. to End COVID-19 Public Health Emergency: What Does This Mean for Pharmacists?
On January 30, 2023, the Biden Administration stated that the COVID-19 Public Health Emergency declaration would end on May 11. First instituted in 2020 by then-President Donald Trump, the PHE declaration has been extended 12 times, fighting back against the COVID-19 pandemic with free tests, vaccines, and treatments for all Americans.
The most immediate result of the PHE ending is that all the costs for COVID testing, vaccination, and treatment will now pass from the federal government to group and individual health plans. But it means more than that for pharmacists and their patients.
However, we are not without hope. Legislative action at the state and federal level could turn this around before the PHE expiration and ensure that patients will continue to benefit from convenient access to their trusted local providers.
Until then, let's explore what the end of the PHE really means for pharmacists and their patients:
What the PHE Ending Means for: Reimbursements
With the end of the Public Health Emergency also comes the end for regulation of reimbursements for COVID-19-related services. The Center for Medicare & Medicaid Services (CMS) has been paying $40 per dose for vaccines administered in outpatient locations, like pharmacies or clinics. However, effective January 1st of next year, that payment will realign with other vaccines.
Additionally, the end of the PHE also means that individual and group health plans no longer have to cover COVID-19 vaccines without cost-sharing or medical management. Plus, where out-of-network providers were required to be reimbursed a reasonable amount for the COVID-19 services under the PHE, that will no longer be the case.
What the PHE Ending Means for: Pharmacist Well-being & Burnout
The end of reimbursement regulation also impacts pharmacists in ways beyond their bottom line. While patients will still want to come to their community pharmacy for COVID-19-related services, the pharmacy won't be reimbursed the same. Performing the same services for less pay is not only demotivating, it's also devaluing the hard work that pharmacists do every day.
Smaller reimbursements lead to less money coming in from those services, which would likely mean a reduction in staff or in clinical hours. Either way, it's going to lead to an increased workload for pharmacy staff — plus increased stress.
What the PHE Ending Means for: Patient Access
Declining or disappearing reimbursements for vaccine administration impacts more than just pharmacists. Because pharmacists will be paid less (or not at all) to administer COVID-19 vaccines, many simply won't be able to afford to offer them. And since pharmacists are the most accessible healthcare providers, this means that many individuals may not have easy access to those vaccines anymore.
Unfortunately, even if patients do still have access, they may not be able to afford the vaccines. With the end of the PHE, the COVID-19 vaccine will no longer be free for patients. Same goes for COVID-19 treatments like Paxlovid.
On the testing front, group and individual health plans will no longer be required to cover COVID-19 testing and related services without cost-sharing or medical management. Payers may continue to cover pharmacist-provided services after the PHE ends, but it will be left to their discretion. Also, many Americans will no longer be able to order over-the-counter COVID-19 tests at no charge.
What Can Be Done?
When the nation needed them, community pharmacists stepped up and filled in the provider gaps. Pharmacies became testing centers. Pharmacists and pharmacy technicians administered vaccines by the millions. Without federal legislation to keep those privileges in place, the expiration of the COVID-19 PHE declaration (with the PREP Act to follow soon in 2024) means that those services will be less accessible to the people who need them. And since community pharmacies are often the only healthcare provider for miles in more rural areas, those patients could lose access entirely.
There's still time to pass legislation that can codify the privileges afforded by the PREP Act at the federal level. The ECAPS Act was introduced in March of 2022 in the House of Representatives, but it has failed to pick up steam despite endorsement from numerous pharmacy-related organizations. In the absence of federal legislation, state laws can be created and amended to keep these privileges in place.
Don't let the privileges that have benefitted millions of Americans slip away because of inaction. Call or email your state representatives to see what they plan to do to ensure pharmacists can continue helping their patients in every way they can.