Pharmacy owner: Many insurance companies don’t reimburse well or at all for the COVID pill

KENMORE, NY (WIVB) – A handful of area pharmacies now have access to new COVID antiviral pills, but at least one WNY pharmacy is reporting low reimbursements to properly dispense potentially life-saving drugs.

At the Kenmore RX Center, staff have been working long hours performing COVID testing, COVID vaccinations, and now dispensing this new COVID medicine. There are two, one is made by Merck, the other by Pfizer. If patients take the pills within five days of having symptoms, the drug is known to be effective in preventing them from going to hospital.

“This is a restricted-use drug,” said Jeff Rutowski, pharmacist and co-owner of the Kenmore RX Center. “We are one of the few pharmacies in Western New York to make medications available to their patients.”

Rutowski said he received the pills for free from the government and then gave them for free to patients who had a prescription. But there is a cost to dispensing the drugs and he said they are not always paid for it.

Staff should research the medical history of each patient. These drugs cannot be taken if a person has some medical training and makes sure that their patient is a good candidate for the pills. They also need to make sure the dosage is correct, in some cases changing the dosage for some people taking other medications. All this takes time and time is money because Rutowski has to pay his employees.

“Some studies have indicated that it costs between $10 and $15 per prescription on top of the cost of the product to remain viable.”

So who should pay this cost? Rutowski says that’s up to the insurance company.

According to him, about 15% of insurance companies reimburse him nothing at all for distributing the drug. And he said over 90% of insurance companies reimburse him $10 or less.

“Unfortunately, it’s everywhere,” he said. “Some insurance companies are willing to pay a fair price for the services of a pharmacist, unfortunately other insurance companies prefer to use their money for idk, naming stadiums after themselves or things like that.”

News 4 contacted Highmark Blue Cross Blue Shield and they sent the following statement:

Highmark Blue Cross Blue Shield of Western New York is committed to supporting public health efforts and ensuring access to COVID-19 treatment for our members. We have provided nearly $100 million for the treatment of COVID-19 for our members since the start of the pandemic.

This includes reimbursing pharmacies for the distribution of FDA-cleared emergency COVID-19 antiviral drugs for our members with prescription drug coverage.

We recognize that these COVID-19 antiviral drugs require additional counseling considerations for people receiving them. That is why we have worked to ensure increased reimbursement to pharmacies for dispensing these specific medications to our members.

Corey DeLuca, Vice President, Clinical and Specialty Pharmacy Services

Rutowski said he was happy to provide the drugs to patients and to spend time doing so. He will continue to do so, but as a small family business he said he needed proper reimbursement to keep the lights on.

Kelsey Anderson is an award-winning presenter and journalist who has been part of the News 4 team since 2018. See more of her work here.

Kristan F. Talley