There’s a sign of hope on DIR reform

Ending direct and indirect remuneration (DIR) fees and other abusive PBM practices is a matter of life and death for too many pharmacies. As a nation, we simply cannot afford for pharmacies to continue closing at this rate or for pharmacy deserts to expand.

No doubt, we’ve faced some major disappointments in the fight to end DIR fees and therefore preserve patient access to pharmacists’ services. In July, the Senate Finance Committee marked up a package of legislation that would prohibit spread pricing in Medicaid programs and increase transparency of PBM practices in Medicare. These are matters of critical importance to pharmacists and their patients, and reform is sorely needed. Unfortunately, the bill the committee voted on did not include an amendment to provide relief from DIR fees.

Before that, the bad news that a proposed Medicare Part D rule that would have ensured price concessions were assessed at point of sale would not be finalized dashed hopes for an end to the hardships DIR fees cause pharmacies and patients. Then the Trump administration scuttled a planned end to “safe harbor” protections under the federal anti-kickback statute for the rebates prescription drug manufacturers pay to PBMs, apparently over concerns about a negative impact on beneficiary premiums. Thus, the safe harbor continues for rebates.

But APhA, along with our fellow members of the coalition dedicated to restraining PBM practices that are starving pharmacies to death, remain united in actively educating Members of Congress and administration officials. We want them to know about the dangerous effects DIR fees have on patients and access.

That hard work looks to be paying off. We recently got news that DIR fee reform would be included in an updated version of the bipartisan S. 2543, the Prescription Drug Pricing Reduction Act. The new language would require price concessions to be included in the negotiated price at point of sale under Medicare Part D starting January 1, 2022. Our continued focus on the issue has resulted in bipartisan bill language. Read the new language addressing DIR fees and other pharmacy issues here.

The new language does several other things that pharmacists and pharmacy advocates have long pursued, like prohibiting plans from retroactively recouping fees while still allowing post-POS bonuses and moving up the timeline for standard quality metrics to 2022 at the latest.

APhA and the other members of the coalition—the National Community Pharmacists Association, National Association of Chain Drug Stores, American Society of Consultant Pharmacists, National Association of Specialty Pharmacists, Food Marketing Institute, National Grocers Association, the National Alliance of State Pharmacy Associations—released a statement applauding the news and thanking Senate Finance Committee leaders Sens. Chuck Grassley (R-IA) and Ron Wyden (D-OR) for staying on the right side of this issue.

The timeline of Congress’s actions is hard to predict under normal circumstances, and with impeachment in play, it’s downright impossible to determine when we might see action on S. 2543. Keep your eye on APhA’s Twitter and Facebook accounts and for breaking news and calls for action to contact your legislators. No matter how long it takes, we will never stop fighting to end this scourge and standing up for pharmacists and their patients.