REIMBURSEMENT
Seeking Reform DIR fees are in the spotlight amid a push to rein in drug costs By Mark Hamstra
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rescription drug prices are once again taking center stage in the national political debate, which may indicate a prime opportunity for changes in the contentious relationship between care providers and payers around direct and indirect remuneration, or DIR, fees among others. Community pharmacies have long battled against DIR fees, which consist of various adjustments to the price of drugs covered under Medicare Part D that are assessed after the point of sale. These adjustments can be impossible to calculate at the time the pharmacy bills the patient, which leads to increased costs for patients and reduced income for pharmacies, according to the major pharmacy associations. “Pharmacy DIR fees force community pharmacies to conduct business in an environment of perpetual uncertainty,” the National Association of Chain Drug Stores said in a statement to the Centers for Medicare & Medicaid Services in 2019. “For months after
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dispensing a medication, pharmacies are unsure of their reimbursement for that drug. This uncertainty is derived from not knowing whether and how much additional money will be clawed back at some future date due to imposed DIR fees.” The industry alleges that a loophole in a Department of Health & Human Services rule has allowed DIR fees to escalate exponentially, and it is tackling this issue through legal, legislative and administrative channels. The American Pharmacists Association and the National Community Pharmacy Association, along with several other groups, are parties in a lawsuit filed earlier this year that is seeking to force HHS to implement DIR reform that would close the loophole and make DIR fees visible to pharmacies at the point of sale. In addition, the industry is pushing for DIR reform through the budget reconciliation process in Congress and through support for H.R. 3554/S. 1909, known as the Pharmacy
October 2021 DRUGSTORENEWS.COM
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