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TO:  All Pharmacy Providers

RE:   COVID-19 Prescribing of Paxlovid by Pharmacists

On July 6, 2022, the Food and Drug Administration (FDA) expanded access to COVID-19 treatment by authorizing state-licensed pharmacists to prescribe Paxlovid to eligible patients. Accordingly, pharmacists will be able to submit claims dispensed on or after July 6, 2022 to eligible recipients of Alabama Medicaid for Paxlovid prescribed by a state-licensed pharmacist.

According to the FDA, Paxlovid may be prescribed for an individual patient by a state-licensed pharmacist under the following conditions:

·         Sufficient information is available, such as through access to health records less than 12 months old, or consultation with a health care provider in an established provider-patient relationship with the individual patient, to assess renal and hepatic function; and

·         Sufficient information is available, such as through access to health records, patient reporting of medical history, or consultation with a health care provider in an established provider-patient relationship with the individual patient, to obtain a comprehensive list of medications (prescribed and nonprescribed) that the patient is taking to assess for potential drug interaction.

·         Please see the full FDA updated Emergency Use Authorization (EUA) for Paxlovid here:  https://www.fda.gov/media/155049/download.

Pharmacies should bill claims for Paxlovid through an electronic NCPDP claim.

• Submit $0.00 or $0.01 for Paxlovid provided at no cost from the federal government. 
• A professional dispensing fee of $10.64 will be allowed/reimbursed on claims for Paxlovid.
• For a Paxlovid claim prescribed by a state-licensed pharmacist, enter the NPI of the pharmacist or pharmacy in the prescribing provider field on the claim. These claims must include a Submission Clarification Code (SCC) of 42 indicating that the prescriber ID submitted is valid and prescribing requirements have been met.
• Paxlovid must be administered according to approved labeling per the FDA.