Pharmacists Say DIR Fees Endanger Pharmacies, Patients

In a recent survey conducted by the National Community Pharmacists Association (NCPA), nearly all independent pharmacy owners said direct and indirect remuneration (DIR) fees put patients in jeopardy, while hindering their ability to manage the business, according to a press release.

"Our members say fixing retroactive pharmacy DIR fees should be NCPA's priority for 2018," said B. Douglas Hoey, RPh, MBA, NCPA CEO. "The results of this recent survey will help us make the case to Centers for Medicare and Medicaid Services and members of Congress that a fix is needed, and it's needed now.”

The pharmacist respondents ranked DIR fees as the top concern of 2018, according to the survey.

Read more about the NCPA survey here.

The NCPA found that 78% of respondents are concerned that DIR fees reduce the predictability of cash flow and 75% said the retroactive fees hinder their ability to predict revenue.

"For example, 84% of independent community pharmacy owners say they never know what their final reimbursement will be at the point of sale, and 77% say it takes 4 to 12 months before they learn what the final reimbursement figure will be,” Hoey said.

Another 87% of pharmacists responded that DIR fees push Medicare beneficiaries into the Part D “donut hole,” in which patients are responsible for nearly all of the cost of their prescription drugs, according to the survey. Approximately 69% of respondents said DIR fees increase cost-sharing for patients.

The survey showed that 35% of pharmacists said the DIR fees they pay are never itemized, which prevents them from knowing exactly which charge corresponds with which prescription. Additionally, 82% of respondents reported the way in which DIR fees are linked to quality measures is not indicated, according to the release.

“The only realistic solution is to end the retroactive nature of DIR fees — whether through S 413 / HR 1038, the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, or by the CMS flexing their regulatory muscles in a similar manner,” Hoey said.

The NCPA said it sent in the survey results as a response to CMS’ proposed rule for 2019 Part D plans, which included a request for comments on a proposal to incorporate DIR fees at the point of sale.