ARLINGTON, Va. – Morning Consult Wednesday published an op-ed by NACDS president and chief executive officer Steven Anderson that tells Congress just how critical it is for the wellbeing of patients and pharmacies to enact relief from direct and indirect remuneration (DIR) fees.

Steven Anderson

“A simple truth is emerging about the complex topic known as pharmacy DIR fees: they are as damaging to patients and to pharmacies as advertised,” Anderson wrote.

He described a recent analysis by Adam J. Fein, CEO of Drug Channels Institute, that the fees reached a record $9.1 billion in 2019 and – according to Fein – “have grown faster than most people realize.”

Anderson also noted that IQVIA, which specializes in healthcare data, found that 2,000 pharmacies have closed in the past two years.

“Those not familiar with DIR fees may appreciate an explanation. Conveniently, the term ‘DIR fees’ coincides nicely with the word ‘dire,’ which pretty much sums them up,” Anderson said. “More specifically, DIR fees results from a Medicare regulatory loophole. Payers ‘claw back’ reimbursement paid to pharmacies for Medicare prescriptions, claiming that they can do so based on pharmacies’ performance on quality measures. However, these metrics can lack transparency, vary widely, impose unattainable requirements, and relate to topics out of a pharmacy’s control.

“Two important results flow from this dire situation: these DIR fees needlessly inflate patients’ out-of-pocket drug costs at the pharmacy counter, and they also are forcing pharmacies of all sizes to fill many prescriptions below-cost – an unfair and unsustainable situation.”

Describing potential legislative solutions, he stated, “Among the opportunities now before us, all eyes are on the bipartisan Senate Finance Committee drug-pricing legislation by Chairman Chuck Grassley (R, Iowa) and Ranking Member Ron Wyden (D, Ore.). Currently, that legislation includes important provisions that would address the ability of payers to ‘claw back’ pharmacy reimbursement, as well as establish standardized and relevant pharmacy quality measures.

“In his State of the Union Address, President Trump urged that bipartisan drug-pricing legislation be passed and sent to his desk for signature. Time will tell if DIR fee relief can finally become a reality, but – as the realities of DIR fees become more and more apparent – time is not on the side of patients, nor on the side of pharmacies.”

The continuous flow of information about the consequences of pharmacy DIR fees further validates NACDS’ advertisement that is designed to raise Congress’ awareness that drug-pricing reform must include DIR fee relief.

More information about DIR fees and about NACDS’ pro-patient and pro-pharmacy policy recommendations is available at NACDS’ Access Agenda microsite.