Pharmacist Group Endorses Medicare Part D Transparency Bill

Bill HR 5951 seeks to prevent retroactive fees by Medicare drug plans and pharmacy benefit managers after prescriptions are filled.

The National Community Pharmacists Association (NCPA) announced their endorsement of a new bill that would increase the transparency of Medicare Part D drug spending and reporting.

The new law would also ban direct and indirect remuneration (DIR) fees that can threaten independent pharmacies. The bill was introduced by US Representatives Morgan Griffith (R-VA), Peter Welch (D-VT), Lou Barletta (R-PA), Rod Blum (R-IA), Earl Carter (R-GA), Rick Crawford (R-AK), Walter Jones (R-NC), Cathy McMorris Rodgers (R-WA) and Pete Sessions (R-TX).

The bill, HR 5951, would address clawbacks assessed by Medicare drug plans and pharmacy benefit managers (PBMs) after prescriptions are filled. The law would prohibit these fees after pharmacies fill prescriptions, according to the NCPA.

“Independent community pharmacists are on the front lines helping Medicare beneficiaries access their prescription drugs and get the maximum benefit out of using them properly. Unfortunately, their efforts are greatly undermined by the imposition of huge retroactive fees by PBM corporations that further complicate Medicare drug costs,” said NCPA CEO B. Douglas Hoey, RPh, MBA. “NCPA staff and members have delivered that message to Congress and Medicare repeatedly to raise awareness of the need for action. We commend Reps. Griffith, Welch, and their colleagues on introducing this common-sense legislation to increase transparency in Medicare drug spending. I encourage all community pharmacists to urge their representative to cosponsor this legislation.”

A recent survey from the NCPA found that 67% of respondents received no information regarding DIR fees, and 73% said they never received an itemized list about the fees being collected. Because these fees can run thousands of dollars per month, it can affect the viability of small pharmacies.

Approximately 87% of responding pharmacists said DIR fees can affect patient care, and the ability to continue the business. The bipartisan support for the new bill indicates that despite political policies, US Representatives see the problem with these fees.

According to the NCPA, since they started raising concerns about DIR fees, 18 US Senators and 30 US Representatives have written to the US Centers for Medicare and Medicaid Services (CMS) about the issue, and have pushed for a law to be put in place.

“Increasingly policymakers and the general public are calling for more transparency into prescription drug costs,” Hoey added. “However, with the major escalation in DIR fees, PBM corporations are heading in exactly the opposite direction.”

Since DIR fees are billed after the transaction, the full cost burden falls on the pharmacies, and is not available to be shared by the customers. These fees can also lead to inaccurate prices on Medicare Plan Finder, according to the NCPA.

Importantly, the new law would not increase Part D costs, or stop outcomes-based incentives implemented by the CMS.

“PBM corporation advocates have argued that DIR fees are payments that reward pharmacies," Hoey concluded. “The reality is community pharmacies instead experience penalty-for-performance in order to pay PBM corporations huge DIR fees that they utilize for their own purposes and benefit.”