With the commercialization of Paxlovid, reimbursement for Paxlovid for Medicare beneficiaries is now covered under Part D. However, not all residents are covered by Part D because:
- Approximately 20% of Medicare beneficiaries do not have part D coverage.
- Part D coverage does not extend to Part A SNF stays.
- The coverage by Medicare Managed Care plans varies, and how the MA plan treats “out of network” providers is unclear, which many nursing homes are considered if they don’t have a MA signed contract.
Through this program, participating PAP dispensing sites will be reimbursed for any product dispensed, along with a dispensing fee. Pharmacy enrollment in the Paxlovid USG PAP is managed by Pfizer and its partner, AssistRx. Pharmacies that would like to learn more about participating in the U.S. Government PAP should contact the program vendor at
PharmacyNetworkContract102101@assistrx.com.
A patient needs to sign up to participate in this program and will receive a voucher that can then be provided to a participating pharmacy to receive Paxlovid at no cost. They can visit the
website or call1-877-219-7225 (1-877-C19-PACK).
A challenge with the USG PAP program is that not all LTC Pharmacies are aware of the program or have completed the enrollment process. Providers are encouraged to talk to your LTC pharmacy if they plan to participate in the USG PAP program. If they are unaware of the program, please provide them with the information above or direct them to
CDC site.
Find out if your LTC pharmacy is participating. If not, facilities may need to use the voucher to pick up Paxlovid at a local commercial pharmacy that is participating for residents needing it during their Part A stay.