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News & Press: National

CMS Will Consider Changes to Pharmacy DIR in Part D

Tuesday, November 21, 2017   (0 Comments)
Posted by: Shannon Glaittli
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by NCPA | Nov 21, 2017

In a 713-page proposed regulation, the Centers for Medicare & Medicaid Services announced it will consider a proposal to account for all pharmacy DIR at point of sale, as NCPA has long urged. CMS argues that the change would increase drug pricing transparency and lower costs for beneficiaries. The proposed rule also attempts to address controversial PBM practices that hinder community pharmacy participation in Part D, citing NCPA input in the proposal. The rule proposes a number of positive changes on an array of topics, including:

 • Defining a “mail order pharmacy” as one that delivers covered Part D drugs via common carrier at mail order cost-sharing rates (a definition that would exclude most independent pharmacies);

• Restating opposition to Part D plans restricting access to certain specialty drugs in a manner that contravenes existing access protections;

• Requiring standard terms and conditions for network access; and

• Prohibiting Part D sponsors from excluding certain pharmacies from their retail network just because the pharmacies don’t meet a Part D sponsor’s internal definition of pharmacy type.

Though the rule is only a proposal at this point, it’s clear that CMS is paying attention to – and agrees with – NCPA’s input on several important issues. NCPA will submit comments to CMS before the Jan. 16 deadline and aggressively support key provisions.

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