NACDS urges DIR reform in statement to House committee

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NACDS urges DIR reform in statement to House committee

By Sandra Levy - 02/13/2019
The National Association of Chain Drug Stores on Tuesday submitted a statement to the House of Representatives Committee on Ways and Means, for a hearing titled, “The Cost of Rising Prescription Drug Prices.”

NACDS described the importance of direct and indirect remuneration, or DIR fee reform for reducing patients’ out-of-pocket prescription drug costs, and for pharmacies’ viability. The comments also described the relationship between lower out-of-pocket drug costs and medication adherence.

Earlier this year, NACDS submitted comments to the Centers for Medicare and Medicaid Services in support of the agency’s DIR fee reform proposal described in the proposed rule, “Modernizing Part D and Medicare Advantage to Lower Prices and Reduce Out-of-Pocket Expenses.”

NACDS said in its statement to the House Committee on Ways and Means: “CMS should use their authority to include pharmacy DIR fee reform and the movement towards a pharmacy quality incentive program in the final rule. These changes will lower out-of-pocket costs for beneficiaries and make medicine more accessible, leading to greater adherence and better health outcomes through services such as medication optimization. We urge members of the Committee to voice their concerns to secretary of Health and Human Services and urge the inclusion of these changes in the Final Part D Rule.”

Pharmacy DIR fees increasingly are being misused by payers to retroactively and severely claw back reimbursement to pharmacies for the prescription drugs that they provide to Medicare beneficiaries. For example, payers impose penalties for pharmacies’ alleged failure to achieve certain benchmarks – many of which are vague, undefined, inconsistent, unachievable or outside of the control of pharmacies. Interpretations of specific terms that are used in the Medicare program related to pharmacy reimbursement and drug pricing have led to these claw-backs, and ultimately to higher out-of-pocket drug costs for patients and increased costs for the government, said NACDS.

In its comments, NACDS noted the trust placed in pharmacies, including on topics related to prescription drug savings. “Based on their first-hand experiences with pharmacies and pharmacists, Americans also trust the recommendations of pharmacies and pharmacists on related public policy issues,” NACDS said.

A national poll of registered voters conducted Jan. 4-6, by Morning Consult and commissioned by NACDS found that 69% of registered voters say pharmacists are credible information sources on prescription drug savings, making pharmacists the highest-ranked healthcare professionals in this regard.

Further, 86% of registered voters support pharmacists using their expertise to identify policies that will lower patients’ drug costs and that build on the Know the Lowest Price Act. Enacted in 2018, the Know the Lowest Price Act banned “gag clauses” that prevented pharmacists from informing patients when they can save money by paying cash for a prescription rather than using insurance.