NCPA said it has sent letters to the chair and ranking member of the Senate Finance Committee and to the chair and ranking members of the House Energy and Commerce and the House Ways & Means committees to initiate hearings on the Improving Transparency and Accuracy in Medicare Part D Spending Act (S. 413/H.R. 1038).
The legislation, introduced last month in the House of Representatives and the Senate, would ban the application of DIR fees to pharmacies after the point of sale for prescription drugs dispensed to seniors under Medicare Part D.
“Retroactive pharmacy DIR fees are creating a system of winners and losers,” NCPA chief executive officer B. Douglas Hoey said in a statement. “While pharmacy benefit managers (PBMs) profit, the unpredictable timing and amount of these clawbacks are wreaking financial havoc on pharmacies, seniors and taxpayers.
“NCPA believes these congressional committees should schedule hearings soon on S. 413 and H.R. 1038 to address this unsustainable situation,” he noted.
According to NCPA, which has endorsed both bills, DIR fees have consequences for both seniors and independent community pharmacies.
The association said DIR fees are pushing seniors into Medicare’s “doughnut hole” coverage gap faster, where they must absorb all of the costs for their prescriptions, as well as expediting their entry into the ensuing catastrophic coverage phase, where the government’s costs have risen from $10 billion in 2010 to $33 billion in 2015. In both of those instances, NCPA noted, the PBMs’ co-pay burden disappears, which isn’t the case in the initial phase of coverage.
Meanwhile, independent pharmacies’ ability to plan ahead of time is being impacted by how PBMs currently apply DIR fees, threatening patient access to these pharmacies, especially in underserved communities, NCPA said.
“By requiring PBMs to divulge the costs of prescription drugs for Medicare beneficiaries at the point of sale, these bills fix a problem even the Centers for Medicare & Medicaid Services acknowledges has contributed to rising costs in Medicare Part D,” Hoey added. “A hearing provides the platform for the scrutiny this issue deserves.”