PHARMACY

NCPA awaits forthcoming DIR drug pricing rule

BY Sandra Levy

Ahead of pharmacy benefit manager executives’ appearance before Congress, set for next week, community pharmacists are eagerly awaiting release of a drug pricing rule. If the rule is finalized as proposed, it would move pharmacy price concessions to point-of-sale, eliminating the retroactive nature of pharmacy direct and indirect remuneration, or DIR, fees the National Community Pharmacists Association said.

Since 2014, NCPA and its members have been fighting to fix the pharmacy DIR issue, which will be among high-priority topics discussed at the organization’s 2019 Congressional Pharmacy Fly-In in Washington, D.C. next week.

“The current pharmacy DIR system isn’t transparent, isn’t efficient, and isn’t fair to patients or pharmacies,” NCPA CEO Doug Hoey said. “It’s a one-sided system that leaves other parties at the mercy of PBMs and plans. NCPA wholeheartedly supports moving pharmacy price concessions to point-of-sale, or ideally, eliminating pharmacy DIR altogether. We also support development of a standard set of pharmacy quality measures that truly measure better health outcomes for our patients.”

Pharmacy DIR fees are imposed by plan sponsors and associated pharmacy benefit managers on pharmacies participating in Medicare Part D networks, and NCPA said they currently are being misused to extract reimbursements from pharmacies well after a transaction, Further, NCPA said the fees often are npredictable and seemingly unconnected to a pharmacy’s performance related to adherence and other standards. This makes it difficult for community pharmacies to operate their business and also means beneficiaries face higher cost-sharing for drugs and are accelerated into the coverage gap or “donut hole” phase of their benefit.

“We’ve experienced a skyrocketing increase in the amount of pharmacy DIR, which grew an eye-popping 45,000 percent between 2010 and 2017,” Hoey said. “We’re hopeful that the new rule fixes the inappropriate way pharmacy DIR has been abused.”

 

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