APhA coronavirus watch: DIR fees threaten pharmacies’ sustainability, groups tell Congress

In a letter directed to congressional leaders on May 7, 2020, more than 240 patient advocacy and health care groups urged inclusion of DIR fee reform in the next coronavirus economic stimulus bill. The reforms would reduce patients’ prescription drug costs and help keep pharmacies—many of which serve as a health care hub in underserved communities—open and ready to provide patient care, the groups said. These issues are particularly vital as the nation battles the COVID-19 pandemic.

The letter is addressed to Senate Majority Leader Mitch McConnell (R-KY), Senate Minority Leader Charles Schumer (D-NY), Speaker of the House Nancy Pelosi (D-CA), and House Minority Leader Kevin McCarthy (R-CA).

“We ask that you remove barriers that threaten a pharmacy’s ability to support patients. This can be achieved by enacting much needed pharmacy DIR reform, including clawback and pharmacy performance measure reform,” the letter reads. Patient medication access protects patient health and well-being and leads to a reduction in avoidable emergency department visits. “Members of Congress should not overlook the clear and present opportunity to address these needed reforms this year.”

DIR fees refer to price concessions not reflected at the point of sale for pharmacies participating in Medicare Part D networks. Assessed weeks or months after Part D beneficiaries’ prescriptions are filled, the retroactive fees complicate decisions about staffing and whether to expand or even keep open a business. Pharmacies may not realize until long after a prescription is filled that they didn’t even recoup their costs. According to CMS, the fees have increased by 45,000% since 2010, correlating with a growing trend of pharmacy closures. Approximately 2,000 pharmacies have closed in the past 2 years.

Reform to DIR fees and other PBM practices that jeopardize patient access and increase out-of-pocket costs has bipartisan support. On April 27, 115 U.S. House of Representatives Members issued a letter urging Congress to include provisions that would permanently end retroactive DIR fees to ensure pharmacies remain viable during the public health emergency and beyond.

APhA, along with the National Community Pharmacists Association; National Association of Chain Drug Stores; American Society of Consultant Pharmacists; National Association of Specialty Pharmacists; Food Industry Association (FMI); National Grocers Association; the National Alliance of State Pharmacy Associations; and many state pharmacy associations signed onto the letter.