Bipartisan bill to end retroactive fees on Part D prescriptions reintroduced

In January, Reps. Peter Welch (D-VT), Morgan Griffith (R-VA), Buddy Carter (R-GA), and Cathy McMorris Rogers (R-WA), reintroduced The Improving Transparency and Accuracy in Medicare Part D Drug Spending Act (H.R. 803), which would prohibit Medicare Part D plans’ PBMs from reducing payments retroactively through DIR fees to pharmacies. The policy applies to clean claims submitted by pharmacies under prompt-pay provisions.

Retroactive DIR fees are among pharmacists’ biggest headaches. Pharmacists don’t know until months after a transaction whether they’ve even recouped their costs, complicating decisions about keeping their pharmacies open, expanding their business, and addressing staffing needs. In addition, retroactive price concessions do not pass savings on to the patient because the fees are assessed long after they have left the pharmacy—a barrier to care for Part D beneficiaries.

The soaring price of prescription drugs is one of today’s hottest political topics, and retroactive DIR fees have garnered increased attention by both the Trump Administration and Congress.

In January 2017, CMS warned that the rise in pharmacy DIR fees has increased Medicare costs to the government and forced more beneficiaries into the coverage gap, or “donut hole.” APhA recently commented on a proposed CMS rule that would potentially include pharmacy price concessions and rebates—including DIR fees—paid from manufacturers to PBMs plans at the pharmacy counter.

APhA will also comment on another proposed CMS rule that would, under the anti-kickback statute, expressly exclude rebates on prescription drugs paid by manufacturers to PBMs, Part D plans, and Medicaid managed care organizations from safe harbor protection unless they are shared with patients at the pharmacy counter. Under this proposal, CMS would also create a new safe harbor for “fixed fee” service arrangements between drug manufacturers and PBMs to still provide “pharmacy benefit management services” to health plans that meet specified criteria.