Finalize Proposed Guidance on Reporting of Pharmacy Prtice Concessions To Shine Light on DIR Fees
Medicare beneficiaries currently choosing a 2016 drug plan may be relying on inaccurate data posted on the Medicare Plan Finder website, and pending regulatory guidance could fix this for future years and increase transparency, 11 U.S. lawmakers said in a bipartisan letter to the Centers for Medicare & Medicaid Services.
Alexandria, VA. (October 22, 2015) - Medicare beneficiaries currently choosing a 2016 drug plan may be relying on inaccurate data posted on the Medicare Plan Finder website, and pending regulatory guidance could fix this for future years and increase transparency, 11 U.S. lawmakers said in a bipartisan letter to the Centers for Medicare & Medicaid Services (CMS).
The letter, signed by U.S. Reps. Austin Scott (R-Ga.), Dave Loebsack (D-Iowa) and others, urged CMS to implement its proposed guidance on consistent reporting of pharmacy price concessions in order to give CMS better oversight of the Part D program to protect taxpayers. Specifically, this would be accomplished by standardizing the reporting by prescription drug plan sponsors of price concessions received from, and incentive payments made to, participating network pharmacies. In addition, it would require the these “fees” to be reflected or estimated at the point of sale—which would enable pharmacists to get an accurate picture of what their ultimate reimbursement amount will be.
"As we all work to ensure seniors get the best and most affordable health care possible, we must focus on reducing prescription drug costs and making sure there is ample transparency and consistency in reporting to help the government responsibly manage the program as well as to help our nation’s seniors make better informed decisions,” the lawmakers wrote.
The representatives urged CMS to implement guidance proposed in 2014 that would help to ensure that Part D plan sponsors consistently report “direct and indirect remuneration” (or DIR) fees paid by pharmacies. The proposal, which builds on
during the Bush Administration, received widespread support from NCPA and consumer advocacy organizations including Families USA
, Medicare Rights Center, Center for Medicare Advocacy, Justice in Aging, National Committee to Preserve Social Security and Medicare, National Council on Aging, and others.
commends the efforts of these lawmakers to support better oversight and transparency in Medicare Part D,” said NCPA CEO B. Douglas Hoey, RPh. “Community pharmacists are trying to help Medicare beneficiaries navigate their choices and find the plan that’s right for them. It’s critical to have accurate information to do that. At the same time, community pharmacies are getting hammered by exorbitant DIR fees. They are not properly disclosed and make it nearly impossible to determine their true reimbursement rate for filling Medicare prescriptions and whether it covers their cost to stay in business for patients."
In congressional testimony,
the Medicare Rights Center said consistent reporting
“will not only benefit the Medicare program — and taxpayers — but also improve the accuracy of premium and cost amounts in the Medicare Plan Finder, CMS’ online plan comparison tool, allowing beneficiaries to more accurately gauge plan costs and efficiency.”