Pharmacy Considerations To Support COVID-19 Response

Now that millions of Americans are being urged to stay home to slow the spread of COVID-19, we’ve seen most of the major insurers and pharmacy benefit managers working with employer plan sponsors to increase access to medications. Here are some of the most common accommodations being made and a few words of caution.

Refill restrictions eased. Vendors are working with plan sponsors to increase access to chronic medications by loosening refill-too-soon requirements and by reminding employees of existing benefits. Most plan sponsors already allow for 90-day fills at mail order, and some retail settings, to allow additional access to larger medication quantities.

Caution: Talk with your pharmacy vendor to see if you can monitor for back-to-back 90-day fills. We don’t want to see stockpiling, which could eventually lead to shortages.

Extending authorizations. Some plan sponsors are extending the duration of existing authorizations for drugs subject to prior authorization, step programs and quantity limit overrides. This reduces the administrative burden on the system while supporting access to medication.

Caution: Limiting authorization requirements for newly prescribed therapies may hamper your ability manage the increasing drug spend of those therapies. Consider limiting extended authorizations to existing authorizations only.

Local Rx Delivery. Many pharmacies are offering free local deliveries. Same day delivery may be available for an additional fee. Delivery information and charges are available on the pharmacy websites or by calling them directly. Please keep in mind that not all medications may qualify for this service (e.g., controlled substance prescriptions – narcotics, ADHD medications etc.) and members will need to confirm if their specific medications qualify for the free delivery service.

Caution: Your plan may not cover delivery charges. Alert plan enrollees if that’s the case.

At this point, it’s hard to predict how long these accommodations should remain in place. But in the meantime, try setting up periodic reviews with your pharmacy vendor to address:

  • When and how to reintroduce certain restrictions – you may decide to make changes regionally depending on the spread of the virus,
  • The cost impact of allowing greater quantities of medications, especially specialty medications,
  • Whether there are indications of unwarranted stockpiling of non-critical or unindicated medication such as antibiotics or other investigational therapies, and
  • Whether projections can be made to forecast annual spend
Raymond Brown
by Raymond Brown

North American Clinical Pharmacy Leader, Mercer

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