PHARMACY

NACDS, NCPA praise groups supporting DIR fee reform

BY Sandra Levy

The National Association of Chain Drug Stores and the National Community Pharmacists Association today lauded 24 patient and consumer groups for advocating for pharmacy direct and indirect remuneration, or DIR fee reform.

The groups expressed their support of proposed DIR fee reform “to protect beneficiary pocketbooks and health” in a letter to Health and Human Services secretary Alex Azar, and the Centers for Medicare and Medicaid Services administrator Seema Verma.

“CMS reports the use of pharmacy DIR has grown an astonishing 45,000 percent from 2010 to 2017,” the patient and consumer groups wrote in their letter. “This increase has led to increased beneficiary cost-sharing and government costs. The increase in beneficiary cost-sharing makes it harder for struggling beneficiaries to afford their medication and could lead to reduced medication adherence and poorer health outcomes. In response, CMS recently issued a proposed rule to make changes to pharmacy DIR that would lower beneficiary costs.”

DIR fees were originally intended to capture and report rebate amounts paid by manufacturers at the end of the plan year during the reconciliation process in Part D. The fees have become a catch-all category used increasingly by plans to include various pharmacy price concessions, such as fees related to performance-based programs or fees for participation in a preferred network. As a result, pharmacies find themselves in the untenable position of being paid by plan sponsors for prescription services, only to find out later that some of the payment must be returned, the industry organizations said.

“We are grateful to the patient and consumer groups, including the National Consumers League, The AIDS Institute, the National Multiple Sclerosis Society, the Lupus and Allied Diseases Association, and the many others who signed this letter. We also want to recognize and thank the patient groups, including the Arthritis Foundation, who submitted separate comments articulating their important and unique stories on this pressing issue,” said NACDS president and CEO Steve Anderson.

“The impact of retroactive pharmacy price concessions on Part D patients is significant, so it’s important that CMS hear from patient groups whose stakeholders are impacted. We appreciate their willingness to join with us in supporting the DIR provisions in this proposed rule. I have no doubt their input will carry weight with CMS,” NCPA CEO B. Douglas Hoey said.

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