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OPA signs onto letter calling for DIR fee reforms in Part D rule

The Ohio Pharmacists Association (OPA) has joined more than 115 health care organizations by signing a letter supporting pharmacy provisions in the Centers for Medicare and Medicaid Services' proposed Medicare Part D rule. In particular, the letter speaks in favor of provisions in the rule that could require pharmacy direct and indirect remuneration (DIR) fees to be assessed at point of sale rather than after the fact.

National Community Pharmacists Association CEO B. Douglas Hoey, Pharmacist, MBA, issued the following statement:

"NCPA has been relentless in urging CMS to take this action on retroactive DIR fees, and this proposed rule reflects our input. Charged retroactively, DIR fees unnecessarily add costs for patients while creating financial uncertainty for pharmacies. We were pleased the agency announced it is considering a requirement for those price concessions to occur at the point of sale for Medicare beneficiaries. We urge CMS to move forward toward that goal.

"Via this letter, more than 115 health care stakeholders make a case for why the proposed rule is good policy and urge CMS not to waver on it. The current system, which allows pharmacy benefit managers to claw back an undetermined amount of money from pharmacies weeks or months after the transaction, is unfair to patients and unsustainable for small-business pharmacy owners."

The letter points out that the proposed DIR change will save patients money:

"CMS has indicated that, even when considering the potential for slight increases in monthly premiums that CMS predicts, beneficiaries would realize net savings of $10.4 billion. This would also slow beneficiary progression through the phases of the Part D program. These conclusions align with CMS' previous findings that DIR affects beneficiary cost-sharing and CMS payments to plans while also pushing patients into, and through, the coverage gap sooner."

"The time for this opaque pricing gimmick to end is now," added OPA Executive Director Ernest Boyd.

OPA will be working with our regional and national organizations to continue to advocate for comprehensive pricing reform in Part D. We encourage members to contact their members of Congress to share their stories of how these fees impact their practices and most importantly, their patients.

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