DIR Reform

Rising pharmacy DIR fees under Medicare Part D have been harming specialty patients who are living with life-altering and life-threatening medical conditions and the pharmacies that serve them. NASP is committed to lowering out-of-pocket costs for beneficiaries under Medicare Part D, improving the transparency of fees, and ensuring competitive balance under the Medicare Part D program.

Pharmacy DIR fees are monies received by pharmacy benefit managers (PBMs) and Part D plans and include concessions pharmacies are forced to pay after, and sometimes up to six months after, they have dispensed medications to seniors. Pharmacy DIR fees result in profit for PBMs/payers while forcing pharmacies to fill Medicare prescriptions below cost.

CMS stated in its Medicare Part D proposed rule that pharmacy price concessions (DIR fees) grew a staggering 107,400 percent between 2010 and 2020, with no savings passed onto Medicare beneficiaries.

NASP Encouraged by Biden Administration’s Effort to Reduce Out-of-Pocket Drug Costs for Seniors, Asks That More Be Done to Protect the Pharmacies that Support Them, written by NASP, March 8, 2022.

NASP actively works on behalf of it’s members and the specialty pharmacy industry to combat rising DIR fees and advocate for specialty patients necessary access to specialty medications and services. See NASP’s history of activities below: