Positive news on DIR fee reform

Dec 17, 2021

On Tuesday, December 14, the Center for Medicare and Medicaid Services (CMS) sent a letter to top DIR congressional allies, including Rep. Buddy Carter (R-GA), Senator Sherrod Brown (D-OH) and others, responding to their inquiries about DIR fees. In very positive news, CMS Administrator Brooks-LaSure committed that CMS will use its regulatory authority to address these post-claim-adjudication fees imposed by PBMs upon pharmacies and providers.

In her letter, Administrator Brooks-LaSure stated, “The agency has continued to study the role that pharmacy price concession fees play in the prescription drug marketplace. CMS agrees that the significant growth in DIR amounts is troubling and is planning to use our administrative authority to issue proposed rulemaking addressing price concessions and DIR.”

Given Brooks-LaSure’s firm commitment, we expect CMS to introduce a proposed rule in the coming months on the issue. We’ll continue to keep you updated as the situation progresses in 2022.