NCPA to CMS: Address 91,500% hike in DIR fees

Doug Hoey, CEO of the National Community Pharmacists Association today called for immediate action after the Centers for Medicare and Medicaid Services disclosed in a budget document that retroactive direct and indirect remuneration, or DIR, fees increased 91,500% between 2010 and 2019.

“This is absolutely unsustainable,” said Hoey. “Community pharmacies are essential health care providers. In many communities, they are the only accessible healthcare provider. Unless Congress and the administration put an end to this ... those health care providers will disappear.”

According to the fiscal year 2022 budget justification estimate sent to Congress by CMS, pharmacy DIR fees increased by 91,500% between 2010 and 2019. The typical community pharmacy now pays roughly $81,000 per year in DIR fees, according to NCPA research.

NCPA noted that the fees are assessed after the point of sale – sometimes months. As a result, community pharmacies may have difficulty controlling their expenses and managing cash flow — putting their business operations in jeopardy. 

In January, NCPA filed a federal suit against the Department of Health and Human Services to end the way DIR fees are assessed. Community pharmacies, the American Pharmacists Association, and the Coalition of State Rheumatology Organizations lawsuit cites a previous CMS estimate from 2017, which pegged the growth of DIR fees at 45,000%. The new estimate means fees more than doubled between then and 2019.