Federal Employee Insurance Program to Reimburse Pharmacists as Providers for Patient Assessment and Prescribing of COVID-19 Therapy

The U.S. Office of Personnel Management (OPM), the federal agency that administers employer-sponsored health insurance for all civilian federal employees, announced that insurance carriers that provide coverage to federal employees through the Federal Employee Health Benefits Program must reimburse pharmacists for patient assessment and prescribing of nirmatrelvir and ritonavir.

OPM’s guidance to insurance companies states, “On July 6, 2022, the FDA revised its 'Emergency Use Authorization for Paxlovid (nirmatrelvir and ritonavir), to authorize state-licensed pharmacists to prescribe Paxlovid to eligible patients, with certain limitations to ensure appropriate patient assessment and prescribing of Paxlovid.' OPM expects carriers to provide reimbursement for such assessment and prescribing of Paxlovid by state-licensed pharmacists. The availability of Paxlovid through state-licensed pharmacists is important in promoting health equity given that about 90% of Americans live within five miles of a pharmacy.”

OPM’s decision will expand access to clinical services provided by pharmacists for nearly nine million federal employees, retirees, and family members.

This decision also builds on ASHP’s advocacy to expand pharmacist recognition as clinical care providers by Medicare, commercial health plans, and state Medicaid programs. Yesterday, ASHP, along with over 55 partner organizations across 37 states, asked the Centers for Medicare & Medicaid Services (CMS) to take similar action. ASHP’s letter to CMS Director Daniel Tsai requests clarification of requirements for state Medicaid programs to pay pharmacists for test-and-treat services authorized under the Public Readiness and Emergency Preparedness Act.