NCPA Executive Update

NCPA Executive Update delivers insights on legislative, regulatory, policy, and industry developments from NCPA CEO B. Douglas Hoey, Pharmacist, MBA, to NCPA members and pharmacy leaders every other Friday.

Wearing the burden of DIR fees every day | NCPA Executive Update | October 5, 2018

by NCPA | Oct 05, 2018

Dear Colleague,

Doug Hoey

The Maryland Health Commission wants greater transparency in medical costs, so consumers can make decisions about their care, and they came up with a unique way to make their point.

The commission created a website where they sell conversation-starter T-shirts, each with the cost of a common procedure on a black shirt with bold white letters: HIP REPLACEMENT $30,779 – and so on, for knee replacement, hysterectomy, and the like.

It's an interesting way to try to make a point, and it made me wonder: What if pharmacists wore T-shirts with their annual DIR losses emblazoned across the front? But even if we don't wear T-shirts, pharmacists do wear the DIR burden every single day.

NCPA has done just about everything you can think of to make sure lawmakers understand why DIR fees remain a pain point for community pharmacists – and we're moving the needle.

We've met with Trump administration officials at the White House, HHS, and CMS to lay out the negative effects of these onerous fees on community pharmacy. Of course, it's not just about community pharmacists – getting rid of DIR fees would help seniors, lower costs, and preserve pharmacy choice and access too.

But as you well know, PBMs are powerful entities. We've approached this issue strategically, and we see gains all the time. The light bulb is coming on with lawmakers. When we talk to them – and when YOU talk to them – they're understanding what we're saying. They get it. And we've worked across the retail pharmacy community to come to a consensus on eliminating fees and supporting fair pharmacy-specific quality measures. We're speaking with one voice, which increases our influence on Capitol Hill.

Right now, we're anticipating the CMS 2020 Part D rule, which we expect to be released later this fall. We've offered input wherever possible to CMS on this rule, which can address parts of regulation over which CMS has clear authority. We feel that this is our best shot at addressing pharmacy DIR fees. The rule is currently under review for clearance at the White House Office of Management and Budget. We continue to work with CMS on this rule and we are optimistic changes to this practice will be forthcoming.

We're also watching the push to eliminate the "safe harbor" protection for rebates to plans or PBMs involving prescription drugs. It's not directly related to DIR, but it could alter the current rebate structure between manufacturers and PBMs in the drug supply chain and in so doing, impact the current DIR structure within the Part D program. This rule also is under review for clearance at the White House OMB. Still, the CMS rule is our most likely vehicle for real DIR change.

We're far from being ready to declare victory but we see progress and movement. Things in Washington move at a glacial pace, so progress and movement is something to cheer. But we can't stop for a minute. Your efforts – meeting with your members of Congress, submitting comments to the docket on the president's drug pricing blueprint and the Part D 2019 rule – have pushed elimination of DIR fees onto policymakers' radar. This outreach continues to be a key pillar of our advocacy efforts. Keep up the good work, and we will too.

Remember that the House is on recess right now, through the midterms. It's a perfect opportunity to reach out, invite your member to your pharmacy, and put in your personal pitch. NCPA stands ready to help you with everything you need to make the meeting a success.

Email NCPA's or phone him at (703) 838-2671 and he'll be glad to assist. We'll give you the facts and figures you need to make the case for eliminating DIR fees once and for all – facts that can be shared with your representatives in an email, on a call, or ... on a T-shirt!

Doug Hoey