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:
- With United Voice, Pharmacy Praises Bipartisan “Pharmacy DIR Reform” and Pharmacy Access Bill Vital for Patients, Medicare, and Pharmacies June 21, 2023
- NASP Applauds Senate Actions to Address Anticompetitive PBM Practices, April 4, 2023
- NASP Submits Testimony to U.S. Senate Committee on Finance on Unfair and Anticompetitive Practices Impacting Specialty Pharmacy March 31, 2023
- NASP Thanks Biden Administration for Reducing Out-of-Pocket Drug Costs for Seniors and Taking Initial Steps to Address Pharmacy DIR Fees, May 2, 2022
- House Letter to U.S. Department of Health and Human Services Urging DIR Reform, March 16, 2022
- Wyden Urges CMS to Ease Financial Strain on Independent Pharmacies, Medicare Beneficiaries, March 15, 2022
- 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 March 8, 2022.
- Stakeholder Letter to CMS Regarding Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (CMS‐4192‐P), March 7, 2022
- Senate Letter to CMS Brooks LaSure on DIR Fee Proposed Rule, March 7 2022
- NASP Provides Comments to CMS on Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Program [CMS-4192-P], March 7, 2022.
- United States Senator Committee on Finance Letter to CMS, March 7, 2022
- NASP’s Letter to the U.S. Department of Health and Human Services on CMS’s proposed rule for Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (CMS‐4192‐P)
- CMS proposes rule requiring Part D plan sponsors to apply all Rx price concessions to point of sale, January 7, 2022
- Specialty Pharmacies Call for Congress to Act on Pharmacy DIR Fee Reform in Budget Reconciliation Bill, November 12, 2021
- NASP Works with Coalition to Push for Pharmacy DIR Reform Legislation, June 22, 2021
- 249 organizations sign letter urging Congress to reduce senior drug costs by addressing backdoor pharmacy price concessions, June 17, 2021
- Pharmacy Coalition Praises Legislation to Relieve Patients and Pharmacies from Pharmacy DIR Fees, May 27, 2021
- NASP Applauds the Introduction of Bipartisan Legislation to Reduce Drug Costs and Support Medication Access for Seniors with Life-Threatening Specialized Conditions, May 27, 2021
- NASP Comments on CMS Most Favored Nation (MFN) Model Interim Final Rule (CMS-5528-IFC), February 18, 2021
- Pharmacy Groups tell HHS that Any Action on Rebate Rule Must Involve Fixing Pharmacy DIR Fees, July 29, 2020
- NASP Submits Comments to CMS, July 23, 2020
- NASP submits comments to CMS on CMS-1744-IFC, June 1, 2020
- More than ¼ of the House of Representatives Call for Pharmacy DIR Reform Action Now, April 27, 2020
- Bipartisan Support for DIR Reform in Next Congressional Stimulus Bill, April 14, 2020
- NASP submits Comments to CMS on the 2021 and 2022 Proposed Rule, April 7, 2020
- Pharmacy Reimbursement Modernization Needed, Report Says, March 3, 2020
- Specialty Pharmacy Supports State Effort to Regulate PBM Practices, March 3, 2020