Biden is expanding Paxlovid availability. For independent pharmacies, stocking the COVID pill can be a hassle

The White House is ramping up a national expansion of Paxlovid — Pfizer’s life-saving COVID-19 pill — as omicron subvariants continue to spread. The Biden administration has touted the drug’s efficacy in helping to reduce hospitalizations for people with underlying health conditions.

But business owners at local independent pharmacies say that the federal government hasn’t necessarily taken steps to make the drug more accessible.

For Marc Ost, co-owner of Eric’s RX Shoppe in Horsham, the process to get Paxlovid shipped to his store is tedious. Low prescription rates and extensive public health authorizations create a slow application process. Ost and pharmacy co-owner Eric Abramowitz say they are concerned that they will not be able to sustain demand for Paxlovid supplies.

“This is not just a normal medication; this is a life-saving medication, and there’s extra work involved from our end and everything that goes with what we need to do in order to fill the script,” Ost said.

Ost’s pharmacy has been in Horsham for 10 years. Ost said he knows most patients by name, some of whom have underlying medical conditions, which is creating a sense of urgency to have Paxlovid available.

“We probably averaged between five to 10 patients a day [asking for Paxlovid],” says Ost. “Some of the assisted living and nursing facilities, we’re starting to see a little bit more of an uptick with them. It very quickly goes from a handful of our patients to quite a few.”

According to local pharmacists, many community pharmacies are deterred from filling Paxlovid prescriptions due to low reimbursements. Some cite that it hinders accessibility significantly, creating a limited supply for patients to get the medication.

Smaller pharmacies’ lack of access to Paxlovid may be part of a bigger problem related to pharmacy reimbursement paid by state Medicaid programs, according to Robert Frankil, executive director of the Philadelphia Association of Retail Druggists.

For instance, pharmacies’ cost of dispensing Medicaid prescriptions exceeded dispensing fees paid by states, according to a 2020 report commissioned by the National Community Pharmacist Association, National Association of Chain Drug Stores, and National Association of Specialty Pharmacy.

“Most [specialty drugs] are in the $2.00 or less dispensing fee,” said Robert Frankil, executive director of the Philadelphia Association of Retail Druggists. “At what point do you say that it’s not smart business to spend 20 to 30 minutes on a patient to earn $2.00?”

Frankil said that years of low prescription reimbursements are plaguing the current situation of community pharmacies hesitant to apply for Paxlovid. But even with low compensation and being beholden to a “clunky” process, he said pharmacists still want to help their patients.

“Instead of simply calling up your wholesaler and saying, ‘Send me three boxes of Paxlovid,’ you have to go through the Department of Health in Pennsylvania first,” Frankil said. “Then you have the back end problem of compensation for going through all that work. But pharmacies really want to do this.”

In March, the White House created a “Test-to-Treat” locator tool, which featured over 2,000 locations that offered testing and antiviral pills nationwide. This effort allowed on-site medical providers to fill a treatment prescription for people that tested positive for COVID-19. In Philadelphia, there are only three such sites listed on the locator tool.

Larry Jones, executive director of Pennsylvania of Health-System Pharmacists, said that “Test-to-Treat” is not a sustainable program. “Test-to-Treat” also doesn’t necessarily make Paxlovid more accessible since most pharmacists – unlike doctors, physician assistants, and nurse practitioners – cannot write prescriptions.

“Only providers presently authorized can prescribe these drugs,” says Jones. “That is according to the FDA approved emergency use authorization.”

And those “prescribing authorities” are not usually on site at local, independently-owned pharmacies.

Giving pharmacists the authority to fill Paxlovid prescriptions, through emergency use authorization, is something that Eric’s RX Shoppe co-owner Abramowitz believes would streamline the process.

“The ability to be able to have a patient there to test them, monitoring all these all these things, and then be able to write them a prescription — it just makes sense,” he says.

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