Final Medicare Drug Pricing Rule Fails to Lower Prices at the Pharmacy Counter

May 17, 2019 · Advocacy

For Immediate Release

May 17, 2019

Contact: Sheila Arquette, Executive Director, (703) 842-0122

WASHINGTON, DC – The National Association of Specialty Pharmacy (NASP) is extremely disappointed the administration did not initiate much needed reforms to ensure Medicare beneficiaries begin paying less at the pharmacy counter in 2020.  This week, the Centers for Medicare and Medicaid Services (CMS) issued a final Medicare Advantage and Medicare Part D Drug Pricing Rule (CMS-4180-F), deciding not to include much needed reforms of abusive Direct and Indirect Remuneration (DIR) fee practices.  This after CMS’s proposed rule highlighted DIR fee practices by plans and pharmacy benefit managers (PBMs) that result in:  increased costs at the pharmacy counter, quickly pushing seniors into the catastrophic coverage gap, and threatening access to specialty medications for our most vulnerable populations.

“CMS’s decision to turn a blind eye is a significant blow to patients seeking relief from the high out-of-pocket costs they face on drugs at the pharmacy counter and is severely out of step with the administration’s proactive and ambitious approach to confronting practices that drive up patient and government spending on drugs,” said Sheila Arquette, R.Ph., NASP Executive Director.  NASP is concerned for patients and concerned about the continued impact pharmacy DIR fees will have on independent specialty pharmacy’s ability to continue providing life-saving medications and care management services for patients with complex conditions such as cancer, rheumatoid arthritis, multiple sclerosis, cystic fibrosis, and HIV/AIDS.”

Since 2012, NASP members have seen a dramatic growth in the collection of pharmacy price concessions in the form of DIR clawback fees by plans and their PBMs. In its proposed rule, CMS stated that pharmacy price concessions grew more than 45,000 percent between 2010 and 2017, with no savings passed onto Medicare beneficiaries.

“Allowing the continued collection of these fees threatens quality, affordable medication access for seniors while giving the largest PBMs leeway to continue anticompetitive market practices and keep more Medicare dollars for themselves,” says Arquette. “By failing to use its authority to act on reform of DIR fees and move pharmacy price concessions to the point of sale, the administration has failed patients.”

NASP is continuing its review of the policies set forth and justifications provided by CMS in the final rule.  We have long advocated for policymakers to put a stop to DIR fees and we intend to continue efforts in coordination with more than 150 patient and other stakeholder organizations and bipartisan members of Congress who have joined pharmacy in advocating for this needed reform.  NASP calls on Congress to act where the administration has not and eliminate DIR fees this year.

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The National Association of Specialty Pharmacy (NASP) is the only national association representing all stakeholders in the specialty pharmacy industry.  NASP members include the nation’s leading independent specialty pharmacies, pharmaceutical and biotechnology manufacturers, group purchasing organizations, patient advocacy groups, integrated delivery systems and health plans, technology and data management vendors, wholesalers/distributors and ​​​practicing pharmacists.  With over 100 corporate members and 1,500 individual members, NASP is the unified voice of specialty pharmacy in the United States.