LTC Pharmacies Want Better Clarity as Booster Shot Rollout Begins

DATE: September 27, 2021

Skilled Nursing News
By Alex Zorn

After receiving a thumbs up from both the Food and Drug Administration and Centers for Disease Control and Prevention earlier this month, the work now begins for long-term care pharmacies to administer COVID-19 booster shots for nursing home residents and staff.

Others eligible for a third Pfizer shot include those ages 50 to 64 who have underlying medical conditions, as well as adults 18 to 49 with chronic health conditions — so long as they received their second shot of the initial two-dose vaccination at least six months ago.

Those that received the Moderna or Johnson & Johnson vaccines still await approval.

Amber Rogotzke, president at Health Dimensions Group, said that vaccine distribution has been “cumbersome” at times with the additional paperwork, training and staff hours that’s been needed and was pleased to see that “co-administration” was available this time around.

“One of the most challenging pieces of the vaccine administration over the last several months was the requirement (after the initial CVS/Omnicare on-site clinics) to have a set number of doses in order to immunize unvaccinated individuals on-site within the community,” she added.

Lingering concerns from LTC pharmacies

While retail pharmacies CVS and Walgreens largely handled the initial rollout of the COVID-19 vaccine, long-term care pharmacies are expected to also be distributors to nursing homes beginning this month as questions have been raised as to whether the LTC pharmacies have been fully compensated for their efforts to this point.

Dr. David Gifford, chief medical officer of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), expected rollout at nursing homes to be “fairly straightforward.”

But one advocate for the sector Alan Rosenbloom, president and CEO of the Senior Care Pharmacy Coalition, said that for long-term care pharmacies reimbursement has been anything but straightforward.

He estimates that reimbursement for the initial round of vaccines covered only 60% of their cost associated with administering the vaccines.

“There was tremendous confusion for pharmacies as to whether they were eligible [for reimbursement], what they were eligible for and how they proved what revenue losses were,” Rosenbloom explained. “Pharmacies did not have good clarity on what seems to be the applicable parameters, until about two weeks before the last application period closed on Nov. 5, 2020, which didn’t give folks a lot of time to apply.”

Pharmacies that did apply saw disparate results with some seeing their applications flatly denied while others’ funding requests were approved but not to the level they requested, Rosenbloom said.

“We’re happy to participate in the vaccine program, but you have to recognize that we’ve had these losses, and haven’t been compensated for it, and you’re making them worse,” he said.

Long-term care pharmacies’ economic experience through COVID-19 has essentially mirrored the economy of facilities, according to Rosenbloom.

In one study released in December 2020, it was reported that occupancy at skilled nursing facilities was down 13% from pre-pandemic levels, according to a NIC Map data report. Rosenbloom estimates LTC pharmacy revenues were down about 12% to 13% during that time.

Rosenbloom added that there is growing frustration from the sector about the way LTC pharmacies were basically shut out of the process early on and then were left to pick up the pieces.

He felt the U.S. Department of Health and Human Services (HHS) and Health Resources and Services Administration (HRSA) have done nothing to clarify key details or resolve interpretive ambiguities that remain from last year.

“We are concerned that LTC pharmacies will see the disparate and inequitable results they saw last year — some applications denied, some LTC pharmacies receiving relief, some of those receiving relief getting amounts that were inexplicable based on the information submitted, and some receiving relief having it recouped shortly thereafter,” Rosenbloom added.

He said there were “a good chunk of claims” from February through March that have not yet been paid.

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