Public Health Emergency to end May 11

NCPA January 31, 2023

On Monday, the Biden administration announced that the COVID-19 national emergency and the COVID-19 public health emergency will end on May 11. Prior to the announcement, the COVID-19 national emergency was scheduled to expire March 1, and the PHE had been extended through April 11. Now, both will end May 11. What does this mean for pharmacies? Some PREP Act authorities will end on May 11 if not already made permanent through state legislation. As of now, here’s a list of what will change on May 11 with the expiration of the PHE:

  1. Medicare beneficiaries: No cost-sharing for COVID-19 at-home testing, testing-related services, and certain treatments
  2. Medicaid and CHIP: New eligibility pathway to cover COVID-19 testing and testing-related, vaccinations, and treatment services for uninsured individuals; coverage group elected at state option with 100 percent federal matching funds.
  3. Medicaid and CHIP: Group health plans and individual health insurance plans are required to cover COVID-19 tests and testing-related services without cost sharing or prior authorization or other medical management requirements.
  4. Medicaid and CHIP: Group health plans and individual health insurance (including grandfathered plans) must reimburse out-of-network providers for tests and related services.
  5. Medicaid and CHIP: Plans and issuers must cover COVID-19 vaccines without cost sharing even when provided by out-of-network providers and must reimburse out-of-network providers a reasonable amount for vaccine administration; federal regulations specify the Medicare reimbursement rate for vaccine administration is a reasonable amount.

Check here for a full list of implications for coverage, cost, and access after the PHE expiration. Stay tuned for updates on how this affects independent pharmacy.