NCPA to CMS: Insurance Plans Shortchanging Public on New COVID Antivirals

Can you spare $1? That’s what one PBM is paying for a procedure that takes almost an hour!

NCPA January 18, 2022

ALEXANDRIA, Va. (Jan. 18, 2022) – Community pharmacists on the front lines of the omicron surge are being forced to lose money to dispense new oral antiviral medicines based on the stingy fees paid by health insurance companies so far, said the National Community Pharmacists Association today in a letter to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure.

“NCPA asks for immediate intervention before these pharmacies are forced to stop dispensing the oral antiviral drugs because they can’t justify the cost to their business,” wrote NCPA CEO B. Douglas Hoey.

According to Hoey, the fees paid to pharmacies to date range from $10.50 on the high end, still far below the pharmacists’ cost of dispensing, all the way down to $1. That’s what Blue Cross Blue Shield’s Prime Therapeutics thinks pharmacies should be paid for a process that takes nearly one hour and includes dozens of additional procedures and considerations.

“The pharmacies in the first distribution cycle estimate the additional time involved with dispensing the oral antivirals requires a dispensing fee consistent with the COVID‐19 vaccine administration fee of $40. This reflects additional steps such as the non-standard ordering and receiving of the physical product, on-boarding new patients, and participating in the prescriber decision making process (working with prescribers to prioritize limited available doses, accurate data on e-prescriptions, transitioning patients from monoclonal antibodies to oral therapy),” explained Hoey.

He told Brooks-LaSure, “it is unconscionable that Medicare Part D plan sponsors and/or their pharmacy benefit managers (PBMs) are reimbursing pharmacies at these dismal rates, especially when these therapies can avoid costly hospitalizations. NCPA is asking for immediate intervention to ensure continued access to oral antivirals for COVID-19, and that CMS use your full authority to provide Medicare and Medicaid coverage of the additional pharmacists’ costs to dispense these vital therapies.”

Click here to read the letter.


Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing nearly 19,400 pharmacies that employ approximately 215,000 individuals nationwide. Community pharmacies are rooted in the communities where they are located and are among America’s most accessible health care providers. To learn more, visit