Specialty Pharmacies Call for Congress to Act on Pharmacy DIR Fee Reform in Budget Reconciliation Bill

Nov 12, 2021 · Advocacy

WASHINGTON, DC – As Congress continues to develop and advance budget reconciliation legislation, specialty pharmacies are alarmed that the House has not included pharmacy direct and indirect (DIR) remuneration fee reform.  These rising DIR fees under Medicare Part D are harming specialty pharmacies and their patients who are living with life-altering and life-threatening medical conditions.

National Association of Specialty Pharmacy President and CEO Sheila Arquette, RPh stated, “Congress has a real opportunity right now to reduce senior drug costs through pharmacy DIR reform, ending a decades long effort that has manipulated drug costs under Medicare Part D while directly hurting the specialty pharmacies that serve patients with conditions like multiple sclerosis, hemophilia, or cancer.”

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) told Congress that DIR fees have more than skyrocketed, 91,000% since 2010. 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.  If Congress were to reform pharmacy DIR fees, the reform would reduce the amount seniors pay for their drugs when they receive them from a pharmacy.

“As the budget reconciliation process continues, NASP urges lawmakers to take immediate action to reform pharmacy DIR fees, utilizing the reforms included in the Pharmacy DIR Reform to Reduce Senior Drug Costs Act (H.R. 3554/S. 1909).  We are very concerned this much needed reform is not in the House bill today despite broad interest on Capitol Hill in addressing this fixable problem.  The implications of these fees are clear, affecting drug affordability and pharmacy access across the U.S., even during a pandemic.  The time to act is NOW.”