NCPA razor-focused on DIR fees issue

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Persistence is paying off for the National Community Pharmacists Association in its advocacy for more transparency with DIR fees.

In a posting in its “The Dose” blog this week, NCPA noted that it continues to build congressional support in getting the Centers for Medicare & Medicaid Services (CMS) to finalize its guidance on direct and indirect remuneration fees (DIR fees). The association said three more congressmen — Reps. Ralph Abraham (R., La.), William Keating (D., Mass.) and Seth Moulton (D., Mass.) — have sent letters to CMS calling for action on the issue.

“Some PBMs/Part D plan sponsors have manipulated how and when to report certain price concessions received from or incentive payments made to pharmacies related to drugs dispensed to Medicare beneficiaries,” Abraham wrote in his letter to CMS. “Such manipulation has resulted in an unfair playing field as the price of a drug out the door from a given pharmacy to a beneficiary can appear higher or lower on the Medicare Plan Finder, depending on how and when certain payments and discounts are accounted for by Medicare Part D plans.”

Abraham noted that in talks with independent pharmacies in his districts, some pharmacies have waited as much as five months to find out DIR fee amounts from PBMs. “This is no way for an industry to run,” he said in the letter. “CMS finalizing guidance on their DIR rules would be a positive step toward consistent and fair reporting.”

In June, NCPA reported that 16 U.S. Senate and 30 House members have written to CMS urging that more accurate information on DIR fees be provided to Part D beneficiaries, pharmacies and the federal government. The association said CMS’ proposed guidance would standardize the reporting by Part D sponsors of price concessions received from, and incentive payments made to, participating network pharmacies. It also would require that the DIR fees be reflected or estimated at the point of sale, which would give pharmacists an accurate picture of their reimbursement amount.

“We write to join our colleagues in support of the Medicare proposed guidance for pharmacy benefit managers (PBMs) and Part D plan sponsors that requires regular and frequent reporting of pharmacy drug price concessions,” Keating and Moulton wrote in a joint letter to CMS.


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