ALEXANDRIA, Va.  — As pharmacy benefit manager executives prepare to be hauled before Congress next week to defend their business practices, community pharmacists are eagerly awaiting release of a drug pricing rule that, if finalized as proposed, would move pharmacy price concessions to point-of-sale, eliminating the retroactive nature of pharmacy direct and indirect remuneration (DIR) fees. Since 2014, the National Community Pharmacists Association and its members have been fighting to fix the pharmacy DIR issue, which will be among high-priority topics discussed at the organization’s 2019 Congressional Pharmacy Fly-In in Washington, D.C. next week.

Doug Hoey

“The current pharmacy DIR system isn’t transparent, isn’t efficient, and isn’t fair to patients or pharmacies,” said NCPA chief executive officer B. Douglas Hoey. “It’s a one-sided system that leaves other parties at the mercy of PBMs and plans. NCPA wholeheartedly supports moving pharmacy price concessions to point-of-sale, or ideally, eliminating pharmacy DIR altogether. We also support development of a standard set of pharmacy quality measures that truly measure better health outcomes for our patients.

“We’ve experienced a skyrocketing increase in the amount of pharmacy DIR, which grew an eye-popping 45,000 percent between 2010 and 2017,” he continued. “We’re hopeful that the new rule fixes the inappropriate way pharmacy DIR has been abused.”

Hoey also urged members of the Senate Finance Committee and the Energy and Commerce Committee, which are set to grill PBM executives next week, to demand answers on why their profits are soaring while very little savings are being passed down to patients.

“PBMs were originally created to control the cost of prescription drugs. If that ever was happening, it’s not happening anymore,” Hoey said. “Congress should ask whether the system that they’ve created is really good for pharmacy small businesses, taxpayers, or patients. We have no doubt that these large corporations and the outrageous fees they charge are driving higher prescription drug costs and killing small-business pharmacies.”

Pharmacy DIR fees are imposed by plan sponsors and their PBMs on pharmacies participating in Medicare Part D networks, and currently are being misused to claw back reimbursements from pharmacies well after a transaction. Further, the fees are often unpredictable and seemingly unconnected to a pharmacy’s performance related to adherence and other standards. This makes it difficult for community pharmacies to operate their business and also means beneficiaries face higher cost-sharing for drugs and are accelerated into the coverage gap or “donut hole” phase of their benefit.