The lawmakers sent a letter to the Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) strongly urging acting HHS secretary Don Wright and CMS administrator Seema Verma to ensure that rebates and discounts in Medicare Part D help contain skyrocketing out-of-pocket costs for patients.
The letter, championed by Rep. Buddy Carter (R., Ga.), the only pharmacist in Congress, also implores the agencies to ensure patient access to specialty pharmacies, not limited access resulting from “inapplicable Star Rating measures.”
“Medicare Part D has achieved impressive results since enactment,” the letter reads. “We are now in the program’s second decade, and together we face the challenge of defending Part D’s effective, unique, market-based structure, while addressing developments that may jeopardize future success. We look forward to working with the administration on behalf of Part D patients and pharmacists.”
According to QuintilesIMS, drug spending continues to shift from traditional to specialty medicines, with the specialty share of net spending increasing from 23.6% in 2007 to 42.9% in 2016. Last month, HHS’ Office of Inspector General announced it is investigating “Part D Sponsors Reporting of Direct and Indirect Remunerations,” also known as DIR fees.
“Specialty pharmacies make significant contributions to clinical outcomes for patients, which is why we need to stop big PBMs from imposing fees that inflate prescription drug costs for the sickest, most vulnerable seniors — the very patients the Medicare Part D program was designed to protect,” said NASP executive director Sheila Arquette. “Unfair fees imposed by big PBMs threaten the specialty pharmacies that serve the unique needs of patients living with complex, life-altering or life-threatening diseases, and they must not persist.”
A recent paper published in JAMA Internal Medicine finds that, due to the structure of the Medicare Part D benefit design, rebates and remunerations — including DIR fees — actually increase patients’ out-of-pocket costs. The author of the paper, Dr. Peter Bach, calls the current Medicare system “absolutely devastating for people on high-cost specialty drugs.”
NASP launched StopDIRfees.com, with information and testimonials on how big PBMs impose DIR fees “to rig the Medicare system.”