NASP Thanks Biden Administration for Reducing Out-of-Pocket Drug Costs for Seniors and Taking Initial Steps to Address Pharmacy DIR Fees

May 02 · Advocacy

Urges Congress to Work with the Administration to Protect Pharmacies as CMS Delays Implementation of The Rule’s Provisions Until 2024

View the press release here.

WASHINGTON, DC – On Friday, April 29, the Biden Administration released a final regulation for the Medicare Advantage (MA) and Medicare Part D programs, including important reforms affecting seniors and pharmacies.  The National Association of Specialty Pharmacy’s (NASP) President and CEO Sheila Arquette, RPh applauds the Centers for Medicare and Medicaid Services (CMS) for taking steps in the rule to significantly reduce out of pocket drug costs for all Medicare beneficiaries through initial pharmacy DIR reforms, although also expresses disappointment that CMS delayed implementation of these critical reforms until January 2024.   NASP also calls on Congress to further bolster the rule by establishing statutory protections that will support patient access to their pharmacies and ensure fair performance evaluations of specialty pharmacies.  

Arquette stated, “CMS has taken a major step forward toward reducing senior drug costs through some needed pharmacy DIR reforms. However, the rule does not prohibit all retroactive fees on pharmacies. Failure to address all retroactive fees could limit patient access to their pharmacy of choice and negatively impact pharmacy market competition. The rule makes several important reforms, but Congress and CMS must get this right and work together to ensure comprehensive reform of pharmacy DIR fees.”

Pharmacy DIR fees are monies received by pharmacy benefit managers (PBMs) and Part D plans and include price concessions and other fees pharmacies are forced to pay after they have dispensed medications to seniors. Pharmacy DIR fees are manipulated by PBMs/payers and often force pharmacies to fill Medicare prescriptions below cost.

“Pharmacies have waited for these reforms for far too long already. With a gap before implementation, Congress and the Administration must work to prevent further anti-competitive abuses against pharmacies.  Oversight of CMS’s finalized reforms will also be critically important, and additional reforms are needed to ensure reimbursement is reasonable and performance evaluations by plans are fair so that specialty pharmacies can remain open and available in network for specialty patients.”

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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 2,500 individual members, NASP is the unified voice of specialty pharmacy in the United States.