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NACDS RxImpact calls on Senate to support action on DIR fees

NACDS RxImpact pharmacy advocates are urging Senators to sign a letter to Health and Human Services Sec. Alex Azar that is being led by Sen. Shelley Moore Capito, R-W. Va., and Sen. Jon Tester, D-Mont.  The letter describes the negative effects on Medicare patients and on pharmacies of the rapid expansion of the use of  direct and indirect remuneration, or DIR, fees in recent years.

The NACDS RxImpact program has consistently linked pharmacies’ real-world experiences with their legislators to urge action on DIR fees.

In March, pharmacy advocates from all 50 states reached all members of Congress through in-person meetings in Washington, D.C., during NACDS RxImpact Day on Capitol Hill, with DIR fees among the priority issues discussed. This topic also is a focus of NACDS RxImpact Congressional Pharmacy Tours and other events in states and Congressional Districts.

“NACDS thanks Sen. Shelley Moore Capito and Sen. Jon Tester — as well as all of the senators who are signing the letter — for their leadership in explaining the consequences of the current state of DIR fees, and for urging Sec. Azar to not allow the current focus on drug prices to pass without taking meaningful action on this extremely critical issue," said NACDS president and CEO Steve Anderson.

“The senators are making clear the consequences of DIR fees on patients, who are facing higher cost-sharing for drugs and who are hitting the ‘donut hole’ coverage gap more quickly. The Senators also are sharing the real-world jeopardy to patient care when pharmacies learn well after a transaction occurs that some of the payment that they received must be returned to a health plan.”

DIR fees were originally intended to capture and report rebate amounts paid by manufacturers at the end of the plan year during the reconciliation process in Part D. In recent years, however, NACDS said the fees have become a catch-all category used increasingly by payers to include various pharmacy price concessions, such as fees related to performance-based programs or fees for participation in a preferred network. As a result, pharmacies find themselves in the untenable position of being paid by plan sponsors for prescription services, only to find out later that some of the payment must be returned, NACDS said.

In April, the Centers for Medicare and Medicaid Services stated in the Final Part D Rule that it has the authority to take action to remedy this issue and that no legislative action would be needed before it could begin a rulemaking process.
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