Pharmacy “DIR fees” that have exploded by 45,000 percent from 2010 to 2017 are inflating seniors’ out-of-pocket costs for prescription drugs and forcing pharmacies out of business. These pharmacy “direct and indirect remuneration” fees must be addressed in drug-pricing legislation. That message about pharmacy direct and indirect remuneration (DIR) fees is the subject of a new cable, broadcast and digital ad by the National Association of Chain Drug Stores (NACDS).

The ads, which focus on the dire nature of pharmacy DIR fees, coincide with the anticipated legislative markup by the Senate Finance Committee. Other Senate and House panels are writing drug-pricing packages as well.

“As part of drug-pricing legislation or through regulatory action, Congress and the Administration need to address these phantom fees that secretly inflate seniors’ out-of-pocket drug costs and that shutter pharmacies by forcing them to sell prescription drugs often below-cost.”

“About one-quarter of the U.S. Congress signed letters in June urging DIR fee relief. Patient and consumer groups including the National Consumers League, The AIDS Institute, the National Multiple Sclerosis Society, the Lupus and Allied Diseases Association, and many more have called for DIR fee relief. These ads will turn up the volume even more on this crucial message: now, as part of drug-pricing legislation or through regulatory action, Congress and the Administration need to address these phantom fees that secretly inflate seniors’ out-of-pocket drug costs and that shutter pharmacies by forcing them to sell prescription drugs often below-cost,” said NACDS President & CEO Steven C. Anderson, IOM, CAE.

Pharmacy DIR fees result from a Medicare regulation loophole. Often six-to-eight months or more after a pharmacy fills a Medicare prescription, payers are taking back money paid to pharmacies. Payers claim this practice relates to performance on so-called quality measures. Yet these measures can be unknown, unpredictable, inconsistent, and outside of a pharmacy’s control. This practice is unworkable for pharmacies, thousands of which have had to close in recent years. The practice also inflates patients’ out-of-pocket costs because of complexities of how such costs are calculated.

In a January 2019 survey conducted by Morning Consult and commissioned by NACDS, about 7-in-10 voters said they find pharmacists credible for drug-savings solutions, and said they want to see changes in rules by which payers reimburse pharmacies below-cost and unpredictably.
More information about pharmacy DIR fees can be found at NACDS’ AccessAgenda.NACDS.org.