OMB Asked to Review DIR Fee Reforms to Lower Drug Costs for Seniors
Sens. Sherrod Brown, D-Ohio, Shelley Moore Capito, R-W.Va., Jon Tester, D-Mont., and James Lankford, R-Okla., recently sent a letter to the Office of Management and Budget to review a proposed rule from the Centers for Medicare and Medicaid Services that would help lower out-of-pocket prescription drug costs for seniors.
The rule, known as the “proposed rule for Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Program,” would help reform pharmacy direct and indirect remuneration, known as DIR.
According to CMS data, DIR fees grew more than 107,400% between 2010 and 2020.
Pharmacy DIR fees applied after the point-of-sale can increase patients’ out-of-pocket costs for Part D drugs.
As such, the increase in DIR fees contributed to a rise in the cost of prescription drugs for patients and the closure of hundreds of pharmacies across the country, according to the letter.
The reform would bring DIR fees to the point-of-sale, instead of after, thus reducing out-of-pocket costs that seniors pay for prescription drugs by $21.3 billion over 10 years.
The rule would also prevent retroactive pharmacy DIR fees, meaning more transparency about fees would be provided at the point-of-sale.
The letter requests that OMB review the proposed CY23 rule from CMS as quickly as possible to give time for CMS to finalize and implement the DIR fee reforms in the Medicare program ahead of 2023.
The senators also suggest that beyond DIR fee reform, additional attention should be paid to standardizing pharmacy performance metrics, ensuring reasonable reimbursement and protecting the rights of pharmacies participating in Medicare Part D.
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