DIR fees are fees that pharmacy benefits managers (PBM) assess on pharmacies for purportedly failing to meet quality measures that many pharmacies believe are arbitrary, anticompetitive and unlawful.
After the Center for Medicare and Medicaid Services (CMS) recently missed an opportunity to include an administrative fix to DIR fees when the agency finalized and modernized Part D rules and guidelines (CMS-4180-P rule), AHF joined more than 200 other pharmacy stakeholder groups, pharmacists and patient advocacy organizations—including many independent pharmacies and other specialty pharmacies—in signing on to the letter, spearheaded by the National Community Pharmacists Association (NCPA), and addressed to Senate Finance Chair Chuck Grassley (R-IA) and Ranking Member Ron Wyden (D-OR).
In their letter, the groups note that “…DIR fees on pharmacies participating in Part D grew by 45,000 percent between 2010 and 2017,” and that the “…increase is unacceptable and unsustainable and it creates uncertainly not only for community pharmacies, but also for the patients who rely on Part D prescription drugs.”
AHF and many independent pharmacies believe that PBMs are not creating or applying DIR fees in good faith.
“The fees are an underhanded way for PBMs to drive competing, often smaller or specialty pharmacies out of business and then take the business to themselves and their own pharmacies,” said Laura Boudreau, Chief of Operations/Risk Management and Quality Improvement for AHF. “We support using legitimate quality measures to incentivize pharmacies to provide excellent care to patients, but that is not what these fees do. The standards are vague and mysteriously applied – often many months or even a year after the fact. These clawbacks sometimes mean pharmacies are paid less than the cost of the drugs. Some quality measures make no sense when applied to pharmacies—especially pharmacies like AHF’s that serve a special needs population. As more small and specialty pharmacies are driven out of business by these oppressive practices, patients—especially those with chronic conditions like HIV—are harmed because they lose their trusted pharmacist. They are often forced into faceless PBM pharmacy constructs that are not knowledgeable about or sensitive to patients’ needs.”
AHF, which operates 48 individual AHF Pharmacy locations, not only provides access to life-saving HIV/AIDS medications, but its pharmacists and pharmacy techs also counsel patients to promote adherence to their medications in an effort to improve patients’ health outcomes.
The groups’ letter to Sens. Grassley and Wyden concluded “If CMS will not act then Congress must.”
