Rep. Carter’s Letter on Reducing Patient OOP Costs

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Rep. Buddy Carter championed and sent a letter to HHS and CMS on Ensuring Rebates and Discounts in Medicare Part D Help Reduce Patient OOP Costs. Despite the strong opposition it generated from the Pharmaceutical Care Management Association (PCMA), Blue Cross Blue Shield Association, and newly the Citizens Against Government Waste, 54 Members of Congress signed the letter in support of ensuring rebates and discounts in Medicare Part D help reduce patient out-of-pocket costs and patient access to specialty pharmacies is not limited by the use of inapplicable Star Rating measures.

We sincerely thank Rep. Carter and his Congressional colleagues, the Community Oncology Alliance (COA), Managed Health Care Associates (MHA), select state pharmacy associations and PhRMA in addition to NASP members for their strong support of this very important initiative!

 

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Medicare Part D Pharmacy ‘DIR’ Fees—S. 413 / H.R. 1038

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Published by The National Community Pharmacists Association:

“Ban on Retroactive Fees Would Lower Costs, Help Seniors and Preserve Pharmacy Access

Background
Part D plan sponsors and Pharmacy Benefit Managers (PBMs) extract DIR (Direct and Indirect Remuneration) fees from community pharmacies. Nearly all pharmacy DIR fees are clawed back retroactively months later rather than deducted from claims on a real-time basis. This reimbursement uncertainty makes it extremely difficult for community pharmacists to operate their small businesses. This is the top concern for independent community pharmacists. Moreover, in January 2017 the Centers for Medicare & Medicaid Services (CMS) warned the rise in pharmacy DIR fees has increased Medicare costs to the government and forced more beneficiaries into the coverage gap (or “donut hole”).”

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Congress, please keep your Medicare promises to our seniors

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Published by The Hill:

“Medicare was created in 1966 as a promise to protect our seniors. But the security of aging Americans is increasingly threatened.

Here’s how Medicare Part D is supposed to work: seniors go to the pharmacy of their choosing, exchange their co-pay for medications, and pay a monthly premium toward a Part D insurance plan that is administered by a pharmacy benefit manager (PBM). Unfortunately, big PBMs — the private insurers who sell Medicare Part D plans to seniors — are rigging the system by imposing unfair “direct and indirect remuneration fees,” or DIR fees.”

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Understanding Pharmacy DIR Fees

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DIR is now the number one issue community pharmacists face today. More importantly, it is the number one concern as they strategically plan for the next 3 to 5 years. So what is DIR?

Learn from the experts everything you need to know about DIR; it’s history, how it’s impacting community pharmacy, and what you can do about it.

 

Drug Costs Too High? Fire the Middleman

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Published by Bloomberg:

“A decade ago, Caterpillar Inc. looked at its employee drug plan and sensed that money was evaporating. The bills for pills had increased inexorably, so the company started to rein in its pharmacy benefit manager, or PBM. The managers are middlemen with murky incentives behind their decisions about which drugs to cover, where they’re sold, and for how much.”

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This Is One of the U.S. Health Care System’s Biggest Secrets

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Despite political uproar over U.S. drug pricing, pharmacy benefit managers, or PBMs, such as CVS Caremark and Express Scripts are the only ones that have really managed to lower drug prices for many. But their controversial playbook involves making it harder for some people to access medicines. Bloomberg Gadfly’s Max Nisen looks at how PBMs work within the broken U.S. health-care system.

 

These companies you’ve never heard of are about to incite another massive drug price outrage

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Published by Business Insider:

“It’s easy to see why EpiPen has become the focus of America’s fury over drug prices. It treats potentially deadly allergic reactions — for example, in a child who is stung by a bee — and its price has spiked by over 500% in a few years.

While it’s easy to jump all over drugmakers, like EpiPen’s maker, Mylan, other actors in the healthcare system ought to draw as much scrutiny.”

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An End to PBM Pick-Pocketing

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Published by Morning Consult:

“Usually when your pocket has been picked, you discover the loss pretty quickly. But many of America’s more than 22,000 independent community pharmacies are finding their reimbursements for prescription drugs reduced well after the patient hands over the co-pay and leaves with their medicine. The technical term for this transaction is a “retroactive pharmacy direct and indirect remuneration (DIR) fee.” That’s one way of putting it.

DIR fees pick the pockets of community pharmacies and their patients.”

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DIR Fees Pose a 5-Star Problem for Pharmacies

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Published by the American Society of Health-System Pharmacists:

“To better understand direct and indirect remuneration (DIR) fees, pharmacists should learn how the fees relate to Medicare’s Star rating system, says Sandra Durley, associate director for ambulatory care pharmacy for the University of Illinois (UI) Hospital & Health Sciences System.”

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Are DIR Fees Putting Independent Pharmacies Out Of Business?

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Published by the American Pharmacy Purchasing Alliance:

“The rate of therapeutic drug use in the U.S. has steadily climbed over the years as more people fall ill and seek medical help. This increase should have resulted to a healthy economy among those in the pharmacy business, but what’s happening in real life is actually the opposite. Many independent pharmacies are struggling to make ends meet, and some even decide to close their doors since their losses are too great to recoup.”

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