NCPA survey: Independents feel hampered by DIR fees

Independent pharmacists are indicated to the National Community Pharmacists Association that it should continue to make the case for reform around direct and indirect remuneration, or DIR, fees. The Alexandria, Va.-based group recently conducted a survey of its members in which 84% said they felt DIR fees hinder their businesses.

Seventy-eight percent of independent pharmacists said that DIR fees hinder their ability to plan for their businesses’ future, with three-quarters saying the fees make their cashflow unpredictable. Pharmacists also recognized that patients feel the impact of DIR fees, too, with 69% of those surveyed saying cost-sharing levels increase as a result of the fees, raising a patient’s out-of-pocket costs. And 87% said that DIR fees push patients into the Medicare Part D coverage gap faster, which can lead to high out-of-pocket costs.

“Our members say fixing retroactive pharmacy DIR fees should be NCPA’s priority for 2018,” NCPA CEO Doug Hoey said. “The results of this recent survey will help us make the case to CMS and members of Congress that a fix is needed, and it’s needed now. … The only realistic solution is to end the retroactive nature of DIR fees — whether through S. 413 / H.R. 1038, the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, or by the Centers for Medicare & Medicaid Services flexing their regulatory muscles in a similar manner.”

NCPA attached the survey results to recent comments it sent to CMS regarding its proposed rule for 2019 Medicare Part D plans, which included a request for information on a potential proposal to include DIR fees at the point of sale.

“We commend CMS for addressing in this proposed rule troublesome practices in the Part D program and encourage the agency to implement these provisions to produce greater convenience and savings for Medicare beneficiaries and greater transparency and fairness for pharmacies,” Hoey said in January.