Study: DIR fees, MACs are biggest concerns for rural pharmacists

IOWA CITY, Iowa — Direct and indirect remuneration fees and delayed maximum allowable cost adjustment ranked highest on scales of both magnitude and immediacy for rural pharmacists, according to new research released by the RUPRI Center for Rural Health Policy Analysis.

Nearly 80% of respondents reported DIR fees as a very large magnitude challenge, with 83.3% reporting this as a very immediate challenge. Seventy-eight percent of respondents reported MACs not being updated quickly enough to reflect changes in wholesale drug costs as a very large magnitude challenge, with nearly 80% indicating it as a very immediate challenge.

Also of concern for rural pharmacists is Medicare Part D, with 58.8% of pharmacists reporting being an out-of-network pharmacy for Part D plans was a very large magnitude challenge (an additional 29.0% said large magnitude) and 60.5% said it was a very immediate challenge (an additional 28.1% said moderately immediate), according to the survey, titled “Issues Confronting Rural Pharmacies after a Decade of Medicare Part D.”

Pharmacy staffing, competition from pharmacy chains, and contracts for services for Medicaid patients were less likely to be reported as significant or immediate challenges.

Initial survey participation invitations were e-mailed on June 28, 2016, and follow-ups were sent on July 12, 2016. Responses were received from 118 pharmacies. RUPRI initially received email addresses for 430 independent retail pharmacies from the National Community Pharmacists Association.

NCPA issued the following statement following release of the research:

“The RUPRI Center’s study offers a much-needed exploration of the challenges facing small pharmacies that participate in Medicare Part D. The paper’s conclusions further validate our concerns about DIR fees, maximum allowable cost pricing transparency, and exclusion from ‘preferred pharmacy’ networks.



“Health care should not be dictated by where you live. However, in many rural areas independent community pharmacies are the sole health care providers for many patients. Unfortunately, the business practices of pharmacy benefit manager corporations make it harder for small pharmacy business owners to be profitable. 



“Nearly 80% of the surveyed pharmacies in the RUPRI study found both DIR fees and MAC reimbursements to be a significant challenge for their business, while almost 60% struggled with being out of network. Thankfully, there are legislative solutions pending before Congress that could bring relief on those issues. Health care professionals should urge Congress to pass the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, the Prescription Drug Price Transparency Act, and the Ensuring Seniors Access to Local Pharmacies Act of 2017) to help improve patient access to care.”