U.S. Representatives Welch (D-VT), Griffith (R-VA), Gonzalez (D-TX), Carter (R-GA), Krishnamoorthi (D-IL), Rose (R-TN), Spanberger (D-VA) and Harshbarger (R-TN) and U.S. Senators Tester (D-MT), Capito (R-WV), Brown (D-OH) and Lankford (R-OK) (key leads in italics) recently introduced H.R. 3554/S. 1909 – the Pharmacy DIR Reform to Reduce Senior Drug Costs Act. Good Neighbor Pharmacy, Elevate Provider Network, Specialty Physician Services (Oncology Supply/ION Solutions) and US Bioservices support this important legislation to reform retroactive direct and indirect remuneration (DIR) fees and to lower the cost of prescription drugs in Medicare Part D to ensure patients receive the lowest negotiated price at point of sale. Numerous organizations have expressed their support, including via a joint press statement from 8 national pharmacy associations.
What the Legislation Would Do
H.R. 3554/S. 1909 incorporates some of the original Phair Pricing Act bill language from last Congress. Effective for plan years beginning on or after January 1, 2022, the legislation would:
- Pass all Medicare Part D price concessions, incentive payments, fees and price adjustments negotiated between a pharmacy and PBM or plan to the point of sale;
- Develop standardized pharmacy performance measures; and
- Define specialty pharmacy.
Why this Legislation is Important
H.R. 3554/S. 1909 is critical to helping independent community pharmacists. A few data points to highlight the importance of this legislation for independent pharmacists, specialty physicians and patients include:
- A 2020 report found that DIR fees grew from $229M in 2013 to an estimated $9.1B in 2019.
- An FY22 Centers for Medicare & Medicaid Services (CMS) budget document recently sent to Congress revealed that pharmacy DIR fees increased by 91,500% between 2010-2019.
- CMS has estimated that DIR fee reform will save beneficiaries $7.1B - $9.2B in reduced cost-sharing.
Independent Community Pharmacists – You Can Help!
Take Action by visiting NCPA’s grassroots website to urge your Members of Congress to cosponsor H.R. 3554/S. 1909 – the Pharmacy DIR Reform to Reduce Senior Drug Costs Act and enact DIR fee reform this Congress. Your voice matters!
The AmerisourceBergen Government Affairs and Policy team will continue to advocate for enactment of DIR reform with this Congress.