Pharmacy orgs laud DIR fee and pharmacy access bill as vital for PBM reform
Several pharmacy organizations, including The National Association of Chain Drug Stores, The National Community Pharmacists Association, the National Association of Specialty Pharmacy, the National Grocers Association, FMI—The Food Industry Association and the American Pharmacists Association today praised the bipartisan introduction of the Protect Patient Access to Pharmacies Act (S. 2052)—a bill that would help preserve Medicare beneficiaries’ access to their pharmacy of choice and help stop “pharmaceutical benefit manipulation” that harms patients and pharmacies alike.
U.S. Sens. Jon Tester (D-Mont.), Shelley Moore-Capito (R-W.Va.), Sherrod Brown (D-Ohio), and James Lankford (R-Okla.) introduced the bill. Specifically, the bill would help to foster enforcement of “any willing pharmacy” laws that prevent the exclusion of pharmacies from Medicare plan networks, and would help to prevent the abuse of direct and indirect remuneration fees that have increased prescription drug prices and that have the effect of squeezing out pharmacies, the groups said.
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The groups also said in a joint statement:
“We appreciate the strong bipartisan commitment and leadership of U.S. Sens. Jon Tester (D-Mont,), Shelley Moore-Capito (R-W.V.), Sherrod Brown (D-Ohio) and James Lankford (R-Okla.) to advance this solution to address devastating pharmacy DIR fees and tactics that exclude pharmacies from Part D plan networks and eliminate seniors’ freedom to keep or even choose their pharmacy.
“Pharmacy benefit managers (PBMs) and payers continue to use pharmacy DIR and other fees to manipulate the Medicare program. For more than a decade, these tactics have fueled their profits while inflating seniors’ out-of-pocket prescription drug costs, threatening the viability of pharmacies of all sizes and types and undermining the Medicare program. The Centers for Medicare & Medicaid Services has determined that between 2010 and 2020 pharmacy DIR fees grew by more than a staggering 107,400%. These fees—which are imposed on pharmacies indiscriminately and retroactively—would be impossible to bear for any business. They put pharmacy access in peril in rural, urban and all areas. We applaud the bipartisan bill sponsors for taking action to uphold and enforce the ‘any willing pharmacy’ law to prevent these behaviors that have the ultimate effect of limiting pharmacy access for seniors.
“We appreciate the bipartisan recognition that it is now time to deal with enforcement of the ‘any willing pharmacy’ law and to reform pharmacy DIR fees as one very important aspect of the larger issue of PBM reform. We appreciate the attention that Congressional leaders have brought to the issue of pharmacy DIR fees, which led to initial action in 2022 by CMS. By finalizing a rule that is set to take effect in 2024, CMS took a step forward toward addressing pharmacy DIR fees, but this did not complete the job as pharmacy DIR fee claw backs continue and protections to ensure patient access to pharmacies have not been addressed.
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“We will work with leaders in Congress to enact this legislation this year, achieving comprehensive PBM reform. We need to ensure this job gets done, and gets done completely, for the American people.”
Separately, NACDS president and CEO Steve Anderson said, “Ending DIR fee abuses is essential for patients’ pharmacy access, for lower drug prices and to prevent the baffling expectation that pharmacies fill prescriptions at a loss while PBMs manipulate the Part D program to boost their profits at the expense of seniors. NACDS represents regional pharmacies with as few as four stores as well as national pharmacies—and we emphasize that DIR fee reform is essential for comprehensive PBM reform that matters to all patients and to the diverse pharmacies that serve them.”
In a commonly cited demonstration of the rampant nature of DIR fees, the Centers for Medicare & Medicaid Services has determined that between 2010 and 2020 DIR fees grew by more than a staggering 107,400%, NACDS noted.
NACDS is urging the legislation as an important aspect—among others—of comprehensive PBM reform. The NACDS Principles of PBM Reform demonstrate the actions necessary across payer segments—through federal and state laws, regulations and enforcement—to bring about pro-patient and pro-pharmacy policies.