NCPA met recently with staff of the CMS Innovation Center to advocate for fair payment for independent pharmacies as they develop a model for Medicare and Medicaid coverage of weight loss drugs that would incorporate some of the lower prices for GLP-1 drugs announced by the White House on Nov. 6. We have advocated that the Innovation Center consider how the participation of independent community pharmacies in the dispensing of GLP-1 drugs for weight loss purposes can be enhanced. Many small pharmacies are not dispensing the weight loss versions of the GLP-1 drugs.
The pharmacy reimbursement predicament for these weight loss drugs is the worst under Medicare. We suggested that any model includes a specific ingredient cost reimbursement that covers the cost of the drug and its unique handling and storage requirements, as well as a commensurate professional dispensing fee, consistent with those used by Medicaid fee-for-service programs. We offered data to support our recommendations. NCPA expects to hear what this model will look like and will report out as we learn more in the coming days.
