Pharmacy’s New "Dirty Little F-Word”

Have you heard about the college student who ran out of money? They went to the chancellor and said, “Since I’ve been here a while and have paid you—and I know you have lots of money—I’ll continue to sit in class, take exams, and graduate without any more money going to you.”

Neither have I. It never happens.

Have you heard about the guy who walked into a physician’s office, or physical therapy clinic, or nursing home and did the same? Neither have I. It never happens.

No one who provides a service does it for free. Professionals administer these services, and payment is expected.

Have you heard about the uninsured person who walked into the pharmacy to get their second or third or fourth COVID-19 shot? The billing mechanism for these patients—the Health Resources and Services Administration—is now out of money, and yet we, the pharmacists, are expected to take care of these patients.

In the pharmacy where I work, we use 3 different platforms to complete 1 COVID-19 shot. Drawing up the injection and sticking it in a patient’s arm is the easy part. Reporting the required data to federal government programs, billing the administration fee, and reporting to the state immunization information system takes almost 15 minutes if a patient is new to your pharmacy. Our people in Fayette County, the poorest county in Pennsylvania, appreciate the fact that we do not require online registration. Unlike at the “big chains,” our people show up without appointments and are taken care of.

According to the Pennsylvania Pharmacists Association,¹ pharmacists have administered more than two-thirds of COVID-19 vaccines. I suspect that number is even higher, given the number of pharmacists—like my daughter Gretchen Kreckel Garofoli—who helped head the vaccination effort in West Virginia. Also included in that count would be my wife, Denise Kreckel, who ran clinics for Centre Volunteers in Medicine, where 2400 vaccines were administered on Saturdays.

According to the CDC website,“[The] COVID-19 vaccine is free of charge for everyone. Participating pharmacies will bill private and public insurance for the vaccine administration fee. For uninsured patients, this fee will be reimbursed through the Health Resources and Services Administration’s Provider Relief Fund.”²

At least half the patients who come into the pharmacy will ask why we need their insurance card. “These shots are supposed to be free,” they say. I explain to them that it takes at least 15 minutes of our time to administer a shot, and even though the vaccine is “free”—and even the alcohol pads and syringes are “free”—there is still a cost.

Through December 31, 2021, Medicare was paying for the vaccine. After the first of this year, Medicare Advantage plans had to pay, and again, we battle to get claims paid. Some Medicare Advantage plans have different billing parameters than others, and some just outright refuse to pay. Centers for Medicare & Medicaid Services does not require managed care plans to cover out‐of‐network providers unless the Medicare Advantage plan has an out‐of‐network benefit.

And now, the Health Resources and Services Administration plan has run out of money, so there is no longer a mechanism for pharmacies to get paid for services provided to the uninsured. And even though COVID-19 shots are way down, we still see uninsured patients come in expecting to be cared for, even though there is no money available to pay for our time, our liability insurance, and all our fixed costs required to keep the lights on.

The government has said that COVID-19 vaccines are free, and we as pharmacists are obligated to administer them at no charge. We community pharmacists have been—and still are—the heroes of the vaccine administration efforts. My store has taken care of plenty of uninsured patients. We’ve administered vaccines for “free” to the Medicare Advantage plans that refuse to pay us.

Free has become my new dirty little F-word.

Peter A. Kreckel, RPh, practices community pharmacy in Lemont Furnace, Pennsylvania.

References

1. White coat brigade: PA pharmacists rally on capitol steps for legislation. News release. Pennsylvania Pharmacists Association. Published April 25, 2022. Accessed May 5, 2022. https://www.papharmacists.com/news/603365/White-Coat-Brigade-Pa-Pharmacists-Rally-On-Capitol-Steps-For-Legislation-.htm
2. Federal retail pharmacy program. CDC. Reviewed May 6, 2022. Accessed May 9, 2022. https://www.cdc.gov/vaccines/covid-19/retail-pharmacy-program/index.html