COVID-19 Update: Public Health Emergency Ending & Payment Questions Answered
On Thursday, Governor Reynolds signed the final extension of the state's Public Health Disaster Emergency Proclamation, announcing it will expire at 11:59 PM on February 15, 2022. Iowa's COVID-19 websites, coronavirus.iowa.gov and vaccinateiowa.gov, will be decommissioned on February 16. Read the full press release here.
With the expiration of the Public Health Disaster Emergency Proclamation, there will be operational changes related to the state's pandemic response. The most noticeable change will be how data is reported publicly.
Changes impacting pharmacy practice include:
Statewide Standing Orders (SSOs) for COVID-19 Testing and COVID-19 Vaccination are intended to provide authorization for COVID-19 testing and vaccination which is not otherwise ordered through a treating health care provider, long term care facility medical director, or occupational health provider. Pharmacists are encouraged to move away from the use of the SSOs and adopt processes and routine protocols for vaccine administration. If you have barriers to moving away from the SSOs, please contact Emmeline at email@example.com for assistance.
Long term care centers will need to begin developing plans for access to non-state resources for antigen testing. Following the expiration of the Emergency Proclamation, entities can no longer access state supplies from Homeland Security through WebEOC.
Iowa hospitals will transition to reporting COVID-19 related data directly to the U.S. Department of Health & Human Services instead of the state. IDPH will no longer submit any hospital data to state or federal entities on behalf of the hospitals.
On Monday, January 31, the FDA approved Moderna's COVID-19 vaccine which will now be marketed as Spikevax for the prevention of COVID-19 in individuals 18 years of age and older. Spikevax has the same formulation as the EUA Moderna COVID-19 vaccine and is administered as a primary series of two doses, one month apart. Spikevax can be used interchangeably with the EUA Moderna COVID-19 vaccine to fulfill the vaccination series.
Rapid COVID-19 Tests:
IPA has confirmed with IME that OTC rapid COVID-19 tests will be covered and billable through the MCOs. IME is currently completing coding to allow these to process and is expected to issue an Informational Letter on how to submit claims in the near future. Wellmark has also confirmed they are providing coverage for up to 8 tests per member per 30 days and will reimburse these claims at $14 per test through their PBM, CVS Health. For pharmacies not in network, Wellmark has also confirmed a member can submit a paper claim directly to the PBM for reimbursement.
Pfizer-BioNTech Trisucrose COVID-19 Vaccine:
We have heard from IPA members that claims for the Pfizer-BioNTech covid vaccine trisucrose formulation (gray cap) are being rejected. IME has clarified that those HCPC codes were originally released without an effective date and as such were not originally coded for payment. IME has loaded the codes at the earliest effective date of 9/3/2021 and is updating their systems. IPA expects that claims previously denied will be payable once this coding goes live.
Oral Antiviral Dispensing:
IPA is actively engaged in conversations with payers and PBMs regarding the professional fees currently being paid for care coordination services associated with dispensing oral antivirals. It is confirmed that Wellmark will pay a $10 professional fee for each prescription, and IME will provide the $10.38 dispensing fee for each prescription. IPA continues to advocate both at the state and federal level for more equitable reimbursement consistent with the high level of care pharmacists provide.