Pharmacy orgs: Lack of DIR fee reform in budget reconciliation bill affects seniors’ drug savings

The National Association of Chain Drug Stores recently said that omitting pharmacy direct and indirect remuneration fee reforms from the Build Back Better Act budget reconciliation bill will deprive Medicare beneficiaries of between $7.1 and $9.2 billion over 10 years in reduced cost-sharing for prescription drugs, according to Centers for Medicare and Medicaid Services estimates.

The organization also said that the version of the Build Back Better Act currently under consideration in the U.S. House of Representatives does not include DIR fee reforms that would close a regulatory loophole that artificially inflates seniors’ cost-sharing for prescription drugs, and that otherwise jeopardizes patients and the pharmacies that serve them.

[Read more: NACDS urges House subcommittee to reform DIR fees, standardize performance measures] 

“The failure to include pharmacy DIR fee reform in the budget reconciliation bill is an obvious miss. Patients’ convenient, equitable and reliable access to trusted pharmacists and pharmacies has been front-and-center throughout the pandemic, and it long has been a necessity for millions of Americans,” NACDS president and CEO Steve Anderson, said.

“Congress has an opportunity to include in the budget reconciliation bill the crucial reforms of the Pharmacy DIR Reform to Reduce Senior Drug Costs Act (S. 1909/H.R. 3554). These reforms would prevent artificial inflation of Medicare beneficiaries’ cost-sharing for prescription drugs — reducing costs at the pharmacy counter,” Anderson continued to say. “These reforms also would prevent the unpredictable and unimaginable fees imposed on pharmacies that have increased an astounding 91,500 between 2010 and 2019 according to CMS. IQVIA estimates that between December 2017 and December 2020, almost 2,200 pharmacies closed nationwide.”

[Read more: NACDS, NCPA praise groups supporting DIR fee reform]

In addition, Anderson also noted that DIR fees threaten patients’ access to their trusted pharmacists and pharmacies, and given the crucial role of pharmacy throughout the pandemic these risks should be more apparent than ever before.

“On behalf of patients and the pharmacies and pharmacists who serve them, we appreciate the dedicated work of the Congressional champions of the Pharmacy DIR Reform to Reduce Senior Drug Costs Act in the U.S. Senate and in the U.S. House of Representatives and we implore them to ensure this legislation is incorporated into the budget reconciliation bill prior to its enactment,” Anderson said. 

The National Community Pharmacists Association also expressed disappointment that the House version of the reconciliation bill leaves out provisions to eliminate DIR fees in Medicaid managed care programs. NCPA said it  has pushed negotiators to include these important provisions, repeatedly emphasizing that pharmacy DIR fee reform would save seniors an estimated $7-9 billion while a ban on Medicaid managed care spread pricing and a move to fair and transparent pharmacy reimbursement would save the federal government over $1 billion.