Abstract
The Centers for Medicare and Medicaid Services (CMS) initially created direct and indirect remuneration (DIR) fees with the enactment of Medicare Part D in order to track rebates and other price adjustments made to pharmacy benefit managers (PBMs). PBMs have expanded the use of these fees to “claw back” money from pharmacies on already dispensed medications. Community and specialty pharmacies claim these fees are not transparent, hurt patients and taxpayers, and negatively impact their fiscal bottom line, while PBMs assert that these fees actually reduce premiums for patients. Congress has stepped into the dispute by introducing legislation that would halt retroactive DIR fees.
Get full access to this article
View all access options for this article.
References
1.National Community Pharmacists Association . Frequently asked questions (FAQs) about pharmacy “DIR” fees . http://www.ncpa.co/pdf/faq-direct-indirect-remuneration-fees.pdf. Accessed October 7, 2017 .
2.
Frier Levitt
LLC
. PBM DIR fees costing Medicare and beneficiaries: investigative white paper on background, cost impact, and legal issues . https://www.communityoncology.org/wp-content/uploads/2017/01/COA_White_Paper_on_DIR-Final.pdf. Published January 2017 . Accessed October 7, 2017 .
3.Drug Coverage (Part D) . Medicare.gov: The official US government site for Medicare . https://www.medicare.gov/part-d/. Accessed October 7, 2017 .
4.
Thielemier
B
. The dirt on DIR fees . http://www.pharmacytimes.com/contributor/blair-thielemier-pharmd/2016/07/the-dirt-on-dir-fees. Published July 25 , 2016 . Accessed October 7, 2017 .
5.
Anon
. DIR fees: the clawback trend . http://therigy.com/dir-fees-the-clawback-trend/. Published July 28 , 2017 . Accessed October 7, 2017 .
6.DIR fees . Drug Plan Fees Raise Costs and Threaten Independent Pharmacies . National Community Pharmacists Association website. http://www.ncpanet.org/advocacy/pbm-resources/lack-of-transparency-and-higher-costs/dir-fees. Accessed October 7, 2017 .
7.
Toich
L.
Direct, indirect remuneration fees harmful to many except these managers . http://www.pharmacytimes.com/news/direct-indirect-remuneration-fees-harmful-to-many-except-these-managers. Published February 2017 . Accessed October 7, 2017 .
8.
Toich
L.
Legislation would halt retroactive DIR fees . https://www.specialtypharmacytimes.com/news/legislation-would-halt-retroactive-dir-fees. Published February 2017 . Accessed October 7, 2017 .
9.United States Congress. H.R. 1038 Improving Transparency and Accuracy in Medicare Part D Spending Act . https://www.congress.gov/bill/115th-congress/house-bill/1038. Accessed October 7, 2017 .
10.United States Congress. S. 413 Improving Transparency and Accuracy in Medicare Part D Spending Act . https://www.congress.gov/bill/115th-congress/senate-bill/413. Accessed October 7, 2017 .