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News & Press: Advocacy

Resources Page: Proposed CMS rule DIR Provisions

Friday, December 21, 2018   (0 Comments)
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Amid a number of proposed Part D policy changes, the Centers for Medicare & Medicaid Services' recently proposed rule, Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses, CMS-4180-P, features critical reform of Part D pharmacy price concessions, also known as direct and indirect remuneration or DIR fees. 

NCPA strongly supports the pharmacy price concession provisions in the proposed rule.

Under the current system, pharmacy benefit managers – the middlemen hired by plan sponsors to administer prescription drug benefits – often claw back fees from pharmacies well after a transaction. Those fees, called direct and indirect remuneration, are often unpredictable and seemingly unconnected to a pharmacy's performance related to adherence and other standards. The fees also disadvantage patients, who are assessed a higher cost-share against their Part D deductible rather than the retroactive, lower adjusted price. The result is to push patients more quickly into the so-called Part D donut hole, at which point the patient is responsible for a considerably larger portion of their prescription drug costs.

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