CMS should reimburse community pharmacists for at-home drug delivery, says NCPA

An op-ed piece from Douglas Hoey, RPh, CEO of the National Community Pharmacists Assn., highlights a trend that is arising from many directions in these pandemic days: at-home delivery of pharmaceuticals.

In the piece, Hoey makes the pitch that CMS should recognize (and reimburse for) a growing trend of seniors—not at nursing homes or longterm care facilities—receiving medicine deliveries at home. For oral solids, this is a trivial decision; mail order pharmacies have been filling such prescriptions for decades. But as the pharma industry moves further and further along the trend of specialty products (e.g., injectables via prefilled syringes), the processes become more complicated. Many are distributed via specialty pharmacies; some are supported by hub providers (who in turn are funded by pharma companies); and some are delivered on an outpatient basis by health systems, including the infusion centers that are favored (in some cases) by PBMs looking to lower delivery costs.

And we’re not even talking about the potential future of at-home drug delivery: new online services, offered by (among others) Amazon. Accelerating this trend is the efforts that multiple clinical-trial sponsors are making to deliver products to trial subjects where they live. Post-pandemic, that might become a permanent change in how drug trials are conducted.

According to Hoey, between the e-prescribing standards of the National Council for Prescription Drug Programs (NCPDP), which writes procedures for documenting drug delivery, and CMS, which has coding rules for reimbursements, the operational procedures for documenting at-home delivery are already established. All that is missing is CMS' willingness to reimburse.

For pharma manufacturers, the takeaway—whether or not CMS decides to reimburse—is to pay attention to who, and how, a drug is dispensed to a patient. Those delivery channels can make a difference in patient adherence, outcomes, and, ultimately, successful commercialization of new treatments.