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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DIR Fees: What NCPA Wants from Part D

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Published by Drug Topics:

Direct and indirect remuneration fees have been one of the most contentious issues between retail pharmacists and PBMs and payers, which charge the “clawback” fees months after prescriptions are filled. NCPA members have said DIR fees are the top issue they would like to see resolved in 2017.

“While the proposed CMS guidance will not change existing policy with regard to DIR fees, it does have the potential to require plans to provide greater granularity to CMS on DIR amounts and the types of arrangements they put into place,” said NCPA CEO B. Douglas Hoey, RPh. “The agency has responded positively to many of our previous recommendations, and even issued an analysis showing the financial havoc retroactive pharmacy DIR fees are causing patients, taxpayers, and pharmacies. We urge CMS to consider our latest suggestions on reporting by plan sponsors.”

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House Bill 276 (AS PASSED HOUSE AND SENATE)

Published by The National Community Pharmacists Association:

“By: Representatives Knight of the 130th, Hatchett of the 150th, Meadows of the 5th, Abrams of the 89th, Stephens of the 164th, and others”

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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.

 

Frequently Asked Questions (FAQs) About Pharmacy “DIR” Fees

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Published by The National Community Pharmacists Association:

“Frequently Asked Questions (FAQs) About Pharmacy “DIR” Fees”

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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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