PBMs have substantial experience helping patients get the drugs and vaccines they need, including in times of crisis. PBMs are taking action to help educate the patients we serve about the safety and efficacy of authorized COVID-19 vaccines, including awareness campaigns to promote vaccine uptake.
When the vaccine supply becomes more available and reliable, PBMs will be ready to direct patients to resources for where they can get vaccinated or remind them to get their second dose.
PBMs also stand ready to work with state governments, localities, and health plan sponsors, as well as health care providers and pharmacists, to identify individuals eligible based on current vaccine allocation priorities.
Given the dynamic nature of this situation, PBMs continue to closely monitor all federal, state, and local developments and remain ready to help.
Below are frequently asked questions of PBMs on the COVID-19 pandemic, including access to needed medications and COVID-19 vaccines.
Can I get extra supply of my maintenance medications and other essential prescription drugs?
As patients evaluate their prescription drug needs, PBMs are providing patient care management services and other supports, and encouraging patients to consult government guidance and, as needed, their health care providers on whether extra supply on hand is necessary and safe. Following Centers for Disease Control and Prevention (CDC) advice, patients may wish to have an up-to-date supply of most maintenance medications. Others may opt for mail-service pharmacy, at the time a refill is needed, to access medications safely while being able to stay at home
Patients with questions about their prescription drug coverage, including early refill policies, should contact their prescription drug plan customer service department through the toll-free number on the back of their prescription drug card. Please note that your prescription drug coverage may differ based on your health plan and whether you are covered under Medicare, Medicaid, an employer-sponsored health plan, or commercial health plan. In addition, please note that specific conditions may apply depending on the type of prescription drug (e.g., for controlled substances), as well as other circumstances.
Can I get my medications delivered to my home so I don’t have to go out?
PBMs are committed to helping the patients we serve practice social distancing and stay at home safely with convenient, reliable access to their needed prescription drugs. PBMs recognize that home delivery can provide an alternative way of safely accessing needed maintenance medications and other essential prescription drugs. Some PBMs, in partnership with health plans and pharmacies, are making home delivery more accessible. If you would like to inquire about receiving your maintenance medications to be delivered by mail, call the prescription drug plan customer service department through the toll-free number on the back of your prescription drug card.
If I get my medications delivered, can I do it without having to interact with the delivery person? And at the pharmacy counter, do I still need to sign for my prescription drugs?
Because of the current transmission risk posed by COVID-19 to patients, pharmacy professionals, and mail carriers alike, signature requirements for home delivery often are being waived, unless legally required. PBMs also are working to get federal agencies, states, and other health care stakeholders to temporarily waive signature requirements to keep Americans, pharmacy professionals, and mail carriers safe.
To further support patients feeling confident in not having to physically sign for their prescriptions, the PBM industry joined pharmacy and grocer representatives in June 2020 to outline best practices for documenting signature-free delivery or pick-up of prescription drugs during the COVID-19 public health emergency.
Click here to read: “Best Practice Documentation for Delivery of Prescription Drugs Without a Signature” (June 22, 2020).
Will there be coverage of prescription drugs for the treatment of COVID-19?
Currently, there is only one U.S. Food and Drug Administration- (FDA-) approved antiviral drug for the treatment of COVID-19; click here to learn more about the antiviral drugs that are approved or under evaluation by the FDA. Patients with COVID-19 but who are not hospitalized due to complications arising from the virus should receive care from their health care provider to help relieve symptoms as they would other viral respiratory infections. PBMs are continuously and closely monitoring COVID-19 developments, including emerging treatments. When the U.S. Food & Drug Administration (FDA) approves treatments for COVID-19, PBMs, working with their health plan clients, will facilitate coverage as appropriate.
What’s being done to try to prevent prescription drug shortages?
PBMs are working together with members of the pharmaceutical supply and payment chain to promote undisrupted access to needed prescription drugs during this global pandemic. care for patients and prevent or mitigate drug shortages.
To help Americans access safe, effective medications, pharmaceutical supply, and payment chain companies are collaborating with each other, the FDA, and other federal, state, and local government agencies. Through FDA-led and industry-supported surveillance efforts, data on potential drug shortages allows for optimal management of any disruptions to existing supplies, as well as adjustments and improvements to patient care plans. As part of these efforts, PBMs support clinical guidance for health care providers that balances patients’ need to stay at home, the clinical appropriateness of supply for any given drug, and the need to prevent future drug shortages.
In support of these important efforts, the PBM industry took action to bring together leaders from industries spanning the pharmaceutical supply and payment chain. Convened at the onset of the pandemic in March 2020, the Pharmaceutical Supply and Payment Chain Coalition’s primary concern remains the health and well-being of patients. The Coalition collaborates on efforts to help prevent and mitigate drug shortages, ensure patients have access to much-needed medications and preventative treatments and promote access to COVID-19 countermeasures, including vaccines.
Click here to read: “Guiding Principles for Safe and Efficacious COVID-19 Vaccine Development, Distribution, Allocation, and Mass Immunization” (October 22, 2020).
We all have an important role in preventing drug shortages. Together, we can make sure patients have convenient, reliable access – such as through home delivery and additional supply on hand – to their essential prescription drugs now and in the days ahead.
What can I expect if there are drug shortages for my maintenance medication or treatments for COVID-19?
The FDA has been closely monitoring the drug supply chain for potential disruptions to supply or shortages caused by the COVID-19 pandemic. Through their essential and leading role in monitoring the safety and resiliency of the drug supply chain, the FDA has been in regular communication with more than 180 manufacturers since late January alone to evaluate their entire supply chain, including active pharmaceutical ingredients, finished dose forms, and any components that may be impacted in any area of the supply chain due to the pandemic.
Even with this important ongoing work, many Americans are worried about shortages for their maintenance medications and other essential prescription drugs. If a shortage for a specific medication does occur, PBMs will work with the patient, their prescriber, and their health plan to identify a covered therapeutic substitute and help minimize patient impact caused by a shortage.
What else are PBMs doing to address and help respond to COVID-19?
In addition to taking action to facilitate patients’ access to essential prescription drugs during the COVID-19 pandemic, PBMs are recommending and adopting, in partnership with our employer and health plan clients, a range of approaches to sustain access to needed prescription drugs:
To help facilitate access to our nation’s nearly 70,000 retail pharmacies, PBMs are actively providing information to RxOpen, a central hub created after Hurricane Katrina to help promote uniform, consistent supply-chain information is provided to stakeholders;
To improve health outcomes for all Americans, PBMs are partnering with organizations in the health care industry on private and public sector actions to help Americans receive the care they need;
To help support patients with specific questions and concerns, including assistance in assessing their prescription drug benefits, PBMs are providing toll-free customer support lines, staffed by a dedicated team of professionals trained in COVID-19 and related questions; and
To minimize impacts on patient care associated with drug shortages, PBMs are leading cross-industry collaboration, including with pharmaceutical manufacturers, pharmacies, hospitals, and health plans, to facilitate Americans’ continued access to a safe, effective, and reliable supply of prescription drugs.
What’s the timing and availability for COVID-19 vaccines?
Vaccines must be approved by the FDA under an Emergency Use Authorization (EUA) or Biologics License Application (BLA), then recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP) and adopted by the CDC Director. (COVID-19 vaccines do not need to be recommended as “routine” by ACIP.)
Click here to learn more about ACIP’s current COVID-19 vaccine recommendations.
In addition to recommending COVID-19 vaccines for use, ACIP also is responsible for making allocation recommendations; states and local jurisdictions will ultimately decide who receives vaccines when while vaccine supply is limited.
The Federal Retail Pharmacy Program for COVID-19 Vaccination is a collaboration between the federal government, pharmacy partners, and states and territories to increase access to COVID-19 vaccination across the United States. This partnership involves 21 national pharmacy partners and independent pharmacy networks, representing more than 40,000 retail and long-term care pharmacy locations nationwide. The eligibility criteria for vaccination is determined by each state and territory. Pharmacy partners under this federal initiative will focus on vaccinating individuals who are eligible for vaccination based on these state-selected criteria.
Now that there are authorized and recommended COVID-19 vaccines in the United States, how will they be covered?
Under the Coronavirus Aid, Relief, and Economies Security Act (CARES Act), health insurance plans compliant with the Affordable Care Act are required to cover COVID-19 vaccines that have been authorized by the FDA and recommended by ACIP, without cost-sharing, within 15 business days from ACIP’s recommendation, and are encouraged to cover as soon as possible. Following FDA authorization and ACIP recommendation, PBMs, working with their health plan clients, will facilitate coverage, as the plan client determines, to all authorized and recommended COVID-19 vaccines.
How can I learn more about the safety of COVID-19 vaccines?
The PBM industry is a proud partner of the COVID-19 Vaccine Education and Equity Project, which has developed a range of helpful resources explaining a range of vaccine questions, including on safety and availability.