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

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”).”