NACDS’ Anderson continues to urge DIR fee relief in op-ed

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NACDS’ Anderson continues to urge DIR fee relief in op-ed

By Sandra Levy - 05/08/2019
Medium on Monday published an opinion piece by National Association of Chain Drug Stores’ president and CEO Steve Anderson, entitled, “For American Patients to be Put First, DIR Fee Relief is Essential.”

The piece comes as the industry is just days away from learning the outcome of a pending Medicare rule that will provide relief from pharmacy direct and indirect remuneration, or DIR fees, and "live up to the vision of “American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs.”

Anderson said, specifically, DIR fee relief, proposed by Health and Human Services Secretary Alex Azar, remains essential to save money for patients and for the government alike.

The piece describes a four-part sequence by which DIR fee relief:

  • Will reduce patients’ cost-sharing for medications;

  • Which increases medication adherence — or patients’ taking their medications as prescribed;

  • Which improves overall health; and

  • Which ultimately reduces government costs.


“What is a DIR fee? In simple terms, it is when a payer claws back reimbursement paid to a pharmacy for Medicare prescriptions. These claw-backs often occur months after a drug is dispensed, and they can result in below-cost reimbursement to pharmacies. It also leads to higher cost-sharing for patients. That is because cost-sharing is supposed to be based on a drug’s cost, which is artificially inflated when claw-backs are not figured in,” Anderson wrote.

Anderson continued, “The four-part sequence that I mentioned begins by assuring pharmacy price concessions are part of the calculation of patients’ cost-sharing. The Centers’ for Medicare and Medicaid Services proposed rule, “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses,” estimates that DIR-fee relief would reduce patients’ drug costs by $7.1 to $9.2 billion over 10 years.”

Anderson noted, “If medications cost less, patients would be more likely to take them, and take them correctly. In January 2012, Pharmacy & Therapeutics published a review of 160 studies, which revealed a significant connection between higher drug costs and lower medication-adherence rates.”

Finally, Anderson said, “It is time to reduce patients’ out-of-pocket costs, improve medication adherence, improve health, and reduce overall costs to the government. DIR fee relief remains central to that vision.”

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