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

Mar 08 · Advocacy

NASP asks the Administration to strengthen and finalize proposed rule to address egregious growth of pharmacy “DIR” fees

View Press Release here.

Washington, D.C., March 08, 2022 (GLOBE NEWSWIRE) — This week, the National Association of Specialty Pharmacy’s President and CEO Sheila M. Arquette, RPh, issued comments that laud the Centers for Medicare and Medicaid Services (CMS) for taking steps to reduce out of pocket drug costs for seniors through initial pharmacy Direct and Indirect Remuneration (DIR) reforms. However, NASP urged CMS to do far more to protect patient access to the pharmacy of their choosing and protect specialty pharmacy businesses.

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. 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. CMS estimates that the reforms outlined in its proposal will lead to over $20 billion in savings for seniors.

National Association of Specialty Pharmacy President and CEO Sheila Arquette, RPh stated, “We are extremely grateful to CMS for beginning the process of addressing pharmacy DIR reform. CMS has a real opportunity to reduce senior drug costs through pharmacy DIR reform, and it also has a critically important opportunity to eliminate the practices that are reducing or eliminating patient access to pharmacies of their choosing and reducing pharmacy market competition. The rule makes important reforms but simply does not go far enough. The statistics about the growth of DIR fees speak for themselves and are unsustainable for pharmacies.”

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 has the legal authority to ensure that anti-competitive practices against pharmacies come to an end. Many pharmacies have closed or consolidated as a result of these practices and these reforms are long overdue,” said Arquette.

NASP asked that the proposed rule be finalized this year with immediate additional protections included for pharmacies to go into effect in 2023. Specialty pharmacies throughout the country submitted comments to CMS and over 230 stakeholders joined together to issue comments in a letter that NASP helped to coordinate.

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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 specialty pharmacies, pharmaceutical and biotechnology manufacturers, group purchasing organizations, patient advocacy groups, integrated delivery systems and health plans, technology and data management vendors, logistics providers, wholesalers/distributors and ​​​practicing pharmacists, nurses, and pharmacy technicians. With over 150 corporate members and 2,200 individual members, NASP is the unified voice of specialty pharmacy in the United States.