NACDS, NCPA react to CMS' new drug pricing rule
The Centers for Medicare & Medicaid Services on Thursday issued a new final rule relating to Medicare Advantage and Part D programs, but pharmacy advocates were disappointed that DIR fee reform wasn't part of it. The National Association of Chain Drug Stores and the National Community Pharmacists Association have both been advocates for DIR fee reform and registered their frustration with the final rule.
"We are disappointed and frustrated that this final rule fails to finalize pharmacy DIR reform as proposed, to the detriment of seniors and community pharmacies," the organizations said in a joint statement. "Our organizations have been joined by many pharmacists, pharmacy stakeholder groups, patient advocacy organizations, patients, and members of Congress in advocating that all pharmacy price concessions be included at the point of sale — or eliminated altogether — to provide senior patients with lower costs and pharmacies with more certainty."
NACDS and NCPA added, “In its proposed rule the administration cited the recent 45,000% increase in pharmacy price concessions, an increase that is unsustainable. Pharmacies are in a tenuous situation, and our organizations are exploring all options to accomplish desperately needed reforms to pharmacy DIR. It is necessary for community pharmacies and for the benefit of seniors that this reform take effect as soon as possible,” the statement said.
The organizations have said that DIR fees are misused by payers to claw back reimbursement to pharmacies for the prescription drugs that they provide to Medicare beneficiaries. They have said that penalties for pharmacies’ alleged failure to achieve certain benchmarks have come because the benchmarks often are vague, undefined, inconsistent, unachievable or outside of the control of pharmacies. Misinterpretations of specific terms that are used in the Medicare program related to pharmacy reimbursement and drug pricing have led to these claw-backs, and ultimately to higher out-of-pocket drug costs for patients and increased costs for the government, the organizations said.
"We are disappointed and frustrated that this final rule fails to finalize pharmacy DIR reform as proposed, to the detriment of seniors and community pharmacies," the organizations said in a joint statement. "Our organizations have been joined by many pharmacists, pharmacy stakeholder groups, patient advocacy organizations, patients, and members of Congress in advocating that all pharmacy price concessions be included at the point of sale — or eliminated altogether — to provide senior patients with lower costs and pharmacies with more certainty."
NACDS and NCPA added, “In its proposed rule the administration cited the recent 45,000% increase in pharmacy price concessions, an increase that is unsustainable. Pharmacies are in a tenuous situation, and our organizations are exploring all options to accomplish desperately needed reforms to pharmacy DIR. It is necessary for community pharmacies and for the benefit of seniors that this reform take effect as soon as possible,” the statement said.
The organizations have said that DIR fees are misused by payers to claw back reimbursement to pharmacies for the prescription drugs that they provide to Medicare beneficiaries. They have said that penalties for pharmacies’ alleged failure to achieve certain benchmarks have come because the benchmarks often are vague, undefined, inconsistent, unachievable or outside of the control of pharmacies. Misinterpretations of specific terms that are used in the Medicare program related to pharmacy reimbursement and drug pricing have led to these claw-backs, and ultimately to higher out-of-pocket drug costs for patients and increased costs for the government, the organizations said.