Reimbursement reform tops list of priorities, from DIR fees to rebates.
During the NCPA Fly-In, a legislative action day for the pharmacy profession, HHS Secretary Alex Azar, JD, bestowed great compliments upon the pharmacy profession and community pharmacists in particular.
“In order for patients to truly be in control,” he said addressing the NCPA delegation in Washington, “they need to be empowered with information, and they need partners to help them navigate the healthcare system. I recognize that is a role that America’s pharmacists, especially our community pharmacists, already play every day.”
Azar also said community pharmacists know better than most others in the healthcare field how to put the patient at the center, provide them with peace of mind, and treat them like a person, not a number. “We look forward to working with you to build the system American patients deserve,” he said.
Azar also discussed efforts to remedy areas of complaints surround pharmacoeconomics in the pharmaceutical and affected healthcare industries.
A recurring aspect of the address was the mention of a blueprint of initiatives for achieving the goals of boosting pharmaceutical competition, improving negotiation, creating incentives for lower list prices, and lowering out-of-pocket costs for patients.
Three initiatives that Azar mentioned specifically were actions taken to end pharmacy gag clauses, address DIR fees, and replace the extant rebate system with new, upfront discounts.
According to Azar, the Centers for Medicare and Medicaid Services (CMS) issued a letter to Medicare Part D plans detailing how current trends and practices were unacceptable in Medicare. In addition, Congress sent two pieces of legislation to President Trump banning pharmacy gag clauses throughout the healthcare system.
Regarding DIR fees, Azar said, “We know the burdensome nature of the DIR system can be a real challenge for community pharmacies, while a lot less of a burden for pharmacies owned by the PBM itself.” To address the issue, Congress has allegedly proposed a rule that requires DIR fees to be accounted for at the point of sale, similar to OptumRx UnitedHealthcare’s initiative announced earlier this year.
The benefit for pharmacies, Azar says, is the elimination of the requirement for pharmacies to pay retroactive fees long after medications have been dispensed.
“Fundamentally, addressing DIR fees is about re-examining how powerful interests have taken advantage of systems that were supposed to serve the patient. Unfortunately, the DIR situation is hardly the only place where that’s occurred.”
Furthermore, patients in Part D plans will now be paying based on lower negotiated prices, which will likely save billions of dollars each year in out-of-pocket costs.