WASHINGTON — The National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA) Tuesday praised a bipartisan Senate letter to Health and Human Services Secretary Alex Azar. The letter thanked the Secretary for concepts in the Centers for Medicare & Medicaid Services’ (CMS) proposed rule, Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses, that would reduce patients’ out-of-pocket drug costs through reform of pharmacy direct and indirect remuneration (DIR) fees in the Medicare Part D program.

Steven Anderson

Led by Sens. Shelley Moore Capito (R, W.Va.) and Jon Tester (D, Mont.), and signed by 29 Senators, the letter states: “We believe the policy outlined in the proposed rule would provide needed relief from the impact pharmacy DIR fees have had on patients’ out-of-pocket costs and community pharmacies.”

The Senators point to the staggering increase in pharmacy DIR fees on pharmacies participating in the Part D program, which have increased by “more than 45,000 percent between 2010 and 2017.” The Senators explain that these retroactive fees, which are taken back from pharmacies months later rather than at the point of sale, cause a reimbursement uncertainty that jeopardizes pharmacies. Loopholes in the method of calculating patients’ copayments are such that the fees inflate the patients’ financial responsibility as well.

“We are grateful to Sens. Capito and Tester—and all the Senators who signed the letter—for highlighting the serious repercussions to patients and pharmacies that pharmacy DIR fees cause, and for urging Secretary Azar to finalize this reform quickly to help reduce patients’ out-of-pocket costs, improve patient health outcomes, and reduce overall costs,” said NACDS president and chief executive officer Steven Anderson.

Doug Hoey

“We appreciate the Senators’ support on this vital issue, which urgently needs to be resolved. The increase in pharmacy DIR fees has caused higher costs for patients, which lead to reduced medication adherence and poorer patient health outcomes,” said NCPA CEO B. Douglas Hoey. “As CMS has noted, revising the structure of these fees could result in billions of dollars in savings for patients.”

The Senators conclude by urging Secretary Azar to act swiftly on pharmacy DIR reform to eliminate the retroactive nature of these fees and to pass the subsequent savings on to those who need it most—patients.