Both pharmacy groups state that rule should have addressed DIR fees.
The National Community Pharmacists Association and the National Association of Chain Drug Stores issued a joint statement expressing their frustration at the release of HHS’s final drug pricing rule for Medicare and Medicaid. The final version of the rule fails to reform pharmacy direct and indirect remuneration (DIR) fees.
“We are disappointed and frustrated that this final rule fails to finalize pharmacy DIR reform as proposed, to the detriment of seniors and community pharmacies,” the statement says.
The statement notes that the fees are based on a regulatory loophole that health insurance plans have exploited to increase beneficiary drug costs. “These fees are being misused by payers to claw back reimbursement to pharmacies for the prescription drugs that they provide to Medicare beneficiaries. For example, payers impose penalties for pharmacies’ alleged failure to achieve certain benchmarks-many of which are vague, undefined, inconsistent, unachievable, or outside of the control of pharmacies.”
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The two groups say that there are misinterpretations of some terms used in the Medicare program related to pharmacy reimbursement and drug pricing. This misinterpretation has led to “these claw-backs, and ultimately to higher out-of-pocket drug costs for patients and increased costs for the government,” according to the statement.
“Our organizations have been joined by many pharmacists, pharmacy stakeholder groups, patient advocacy organizations, patients, and members of Congress in advocating that all pharmacy price concessions be included at the point of sale-or eliminated altogether – to provide senior patients with lower costs and pharmacies with more certainty.”
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The proposed rule noted the recent 45,000% increase in pharmacy price concessions, which NCPA and NACDS say is unsustainable. “Pharmacies are in a tenuous situation, and our organizations are exploring all options to accomplish desperately needed reforms to pharmacy DIR. It is necessary for community pharmacies and for the benefit of seniors that this reform take effect as soon as possible.”
Between them, NACDS and NCPA represent more than 62,000 pharmacies drug stores and supermarkets or mass merchants with pharmacies.