On March 7th, 233 patient advocates, healthcare entities, pharmacy associations, retail organizations and companies urged the Biden administration to finalize the Centers for Medicare and Medicaid Services’ proposed rule for the contract year 2023 — so that Medicare patients obtain maximum savings and maintain convenient and equitable access to pharmacies serving them in the Medicare Part D Program.
At issue are direct and indirect remuneration fees, net of all pharmacy incentive payments, that have grown more than 107,400% between 2010 and 2020.
CMS’ proposed rule would revise the definition of “negotiated price” for a covered Part D drug to include all pharmacy price concession DIR fees at the point of sale — a critical step toward comprehensive pharmacy DIR reform, and a vital move that would reduce seniors’ and people with disabilities’ out‐of‐pocket expenses by $21.3 billion over 10 years, the groups said.
“As it stands now, the inconsistent and opaque nature in which these retroactive fees are applied makes it difficult for pharmacies to continue operating, and many pharmacies [of all sizes and formats] have closed, which negatively impacts patient access to care,” the groups wrote in the letter.
Of critical importance, the groups also urged the Biden Administration to establish “standardized pharmacy performance metrics that fairly and reasonably evaluate pharmacies based on the drugs they dispense and services they provide” and ensure a final rule that “eliminates retroactive clawbacks on pharmacies, so they do not continue to compromise beneficiary access to their pharmacy.”
The letter was commended by a pharmacy coalition including The National Community Pharmacists Association; National Association of Chain Drug Stores; National Association of Specialty Pharmacy; FMI; National Grocers Association; and the American Pharmacists Association.