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NCPA Survey: Pharmacy DIR Fees Plague Both Community Pharmacies and Their Patients

Friday, February 9, 2018   (0 Comments)
Posted by: Janet Anderson
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ALEXANDRIA, Va. (Feb. 9, 2018) – According to a survey from the National Community Pharmacists Association, an overwhelming majority of independent community pharmacy owners say retroactive pharmacy direct and indirect remuneration fees undermine patient access to prescription drugs and hinder owners’ ability to manage their businesses.

“Our members say fixing retroactive pharmacy DIR fees should be NCPA’s priority for 2018,” said NCPA CEO B. Douglas Hoey, Pharmacist, MBA. “The results of this recent survey will help us make the case to CMS and members of Congress that a fix is needed, and it’s needed now.

“For example, 84 percent of independent community pharmacy owners say they never know what their final reimbursement will be at the point of sale, and 77 percent say it takes four to 12 months before they learn what the final reimbursement figure will be. The only realistic solution is to end the retroactive nature of DIR fees – whether through S. 413 / H.R. 1038, the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, or by the Centers for Medicare & Medicaid Services flexing their regulatory muscles in a similar manner.”

Among other findings reported by survey respondents:

  • 84 percent said DIR fees hinder their ability to plan for the future of their business.
  • 78 percent said DIR fees make cash flow unpredictable.
  • 75 percent said DIR fees make it hard to predict operating revenue.
  • 87 percent said DIR fees push patients into the Part D coverage gap more quickly, where patients have much higher out-of-pocket costs.
  • 69 percent said DIR fees inflate patient cost-sharing levels, which increases their patients’ true out-of-pocket totals.

In addition, 35 percent of respondents said DIR fees are never itemized to a specific claim. While pharmacy benefit managers claim pharmacy DIR fees are linked to patient health outcomes, 82 percent of respondents said they never receive any information about how the fees are linked to quality measures.

NCPA attached the survey results to comments it submitted in response to CMS’ proposed rule for 2019 Medicare Part D plans, which included a request for information on a potential proposal to include DIR fees at the point of sale.


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