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Industry supports latest House bill addressing DIR fees


WASHINGTON - Rep. Morgan Griffith, R-Va., along with Rep. Peter Welch, D-Vt., and seven other Members of Congress, on Thursday introduced the Improving Transparency and Accuracy in Medicare Part D Spending Act (H.R. 5951), which would ensure community pharmacists receive reimbursement at the rate posted at the time the prescription is filled.

“This bill would make it so pharmacists know exactly what they're getting paid when you get your prescriptions filled," Griffith said. "Unfortunately, pharmacy benefit managers, which operate within insurance companies etc., have gotten into the habit of changing rates paid to your pharmacist for your prescriptions weeks and months after the prescriptions have been filled,” he said. “Some drugs are like a commodity whose prices change. But when the price of gasoline fluctuates with the market, your local gas station isn't allowed to send you a bill after the fact. They can’t say the price was $2.09 when you filled up your tank, but you really should’ve paid $2.15.”

“This simple bill makes it so the PBMs cannot unduly change their reimbursements to your pharmacist after the fact,” Griffith added.

“Rural pharmacies are an essential component of health care delivery in small communities across America," Welch added. "Vermont’s small pharmacies provide quality service and essential medication every day.  Their long term viability is essential to the health of our communities and this legislation will help ensure they succeed in this vital mission."

"Independent community pharmacists are on the front lines helping Medicare beneficiaries access their prescription drugs and get the maximum benefit out of using them properly. Unfortunately, their efforts are greatly undermined by the imposition of huge retroactive fees by PBM corporations that further complicate Medicare drug costs," commented Douglas Hoey, CEO of the National Community Pharmaicsts Association, in support of the bill.  "NCPA staff and members have delivered that message to Congress and Medicare repeatedly to raise awareness of the need for action. We commend Reps. Griffith, Welch, and their colleagues on introducing this common-sense legislation to increase transparency in Medicare drug spending [and] I encourage all community pharmacists to urge their representative to cosponsor this legislation."

According to a recent NCPA survey of 640 community pharmacists, DIR fees are wreaking havoc. Two-thirds of pharmacists (67%) said they receive no information about when DIR fees will be collected or their size. Many said DIR fees can total thousands of dollars each month and make it impossible to determine at the time of dispensing whether the net reimbursement will cover their costs, such as purchasing drugs.

There is broad, bipartisan alarm in Congress and from Medicare officials over DIR fees. In response to concerns raised by NCPA staff and members, 18 U.S. Senators and 30 U.S. Representatives have written to the Centers for Medicare & Medicaid Services to urge the agency to implement proposed guidance to address pharmacy price concessions like DIR fees. CMS has noted "variations in the treatment of costs and price concessions affect beneficiary cost sharing, CMS payments to plans, federal reinsurance and low income cost-sharing (LICS) subsidies, manufacturer coverage gap discount payments, and plan bids." NCPA continues to support that guidance in addition to H.R. 5951.


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