NCPA Asks US Senate and House Leadership to Hold Hearings on Pharmacy DIR Fees Bills


The National Community Pharmacists Association (NCPA) recently requested Congressional hearings on legislation, the Improving Transparency and Accuracy in Medicare Part D Spending Act (S. 413 / H.R. 1038), that would stop the practice of pharmacy direct and indirect remuneration (DIR) fees being applied retroactively under Medicare Part D. The request was made from NCPA to the chair and ranking member of the Senate Finance Committee and to the chair and ranking members of the House Energy and Commerce Committee and the House Ways & Means Committee, the committees with jurisdiction over this issue.

"Retroactive pharmacy DIR fees are creating a system of winners and losers," NCPA CEO B. Douglas Hoey, RPh, MBA said in a press release. "While pharmacy benefit managers (PBMs) profit, the unpredictable timing and amount of these clawbacks are wreaking financial havoc on pharmacies, seniors, and taxpayers. NCPA believes these congressional committees should schedule hearings soon on S. 413 and H.R. 1038 to address this unsustainable situation. By requiring PBMs to divulge the costs of prescription drugs for Medicare beneficiaries at the point of sale, these bills fix a problem even the Centers for Medicare & Medicaid Services acknowledges has contributed to rising costs in Medicare Part D. A hearing provides the platform for the scrutiny this issue deserves."

Both letters make these points:

  • DIR fees are pushing seniors into the donut hole coverage phase faster, where seniors absorb all of the costs for their prescriptions;
  • DIR fees are also pushing seniors into the ensuing catastrophic coverage phase faster, where the government's costs have risen from $10 billion in 2010 to $33 billion in 2015;
  • In both of those instances, the PBMs' co-pay burden disappears, which is not the case in the initial phase of coverage;
  • Independent community pharmacies' ability to plan in advance is being undermined by how PBMs currently apply DIR fees, threatening patient access to these pharmacies, especially in underserved communities; and
  • All of this is occurring while PBMs continue to operate in a non-transparent manner when it comes to DIR fees.

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