NACDS is welcoming the strongest signal yet by the Centers for Medicare & Medicaid Services (CMS) that a standardized pharmacy quality program should be created to help reduce patients’ out-of-pocket drug costs and to help patients maintain critical access to their pharmacies.
Currently, quality measures that often are unknown, unpredictable, inconsistent and beyond a pharmacy’s control are figuring significantly into the direct and indirect remuneration fees, or DIR fees, imposed by payers on pharmacies.
In a statistic that has grabbed the attention of policymakers across parties and in all levels and branches of government, CMS has noted that DIR fees exploded by 45,000 percent in recent years. DIR fees ultimately have the effect of increasing patients’ out-of-pocket drug costs, and of forcing pharmacies of all sizes to fill prescriptions below cost – an unsustainable situation that is contributing to pharmacy closings.
In a new proposed rule, CMS proposes taking action to increase transparency in Medicare Part D plan sponsors’ pharmacy performance measures. Plan sponsors would have to disclose these measures, and CMS would publish them. The CMS rule also recommends principles to guide pharmacy performance measures, urges the industry to work together toward appropriate measures, and indicates the possibility that CMS may incent plans to use appropriate quality measures.
“This is a positive and welcome development from CMS, and we urge the agency to continue to move toward a requirement for a standardized pharmacy quality program. Now, given the dire situation facing pharmacies and the patients they serve, NACDS also urges Congress to act on this momentum and to advance DIR fee relief in a legislative vehicle this year. DIR fee relief includes a standardized pharmacy quality program and prevention of retroactive ‘clawbacks’ of pharmacy reimbursement,” said NACDS President & CEO Steven C. Anderson, IOM, CAE.
NACDS has lauded progress on the inclusion of essential DIR fee relief components in the bipartisan Prescription Drug Pricing Reduction Act by Senate Finance Committee Chairman Chuck Grassley (R-IA) and Ranking Member Ron Wyden (D-OR). The legislation in its current form would establish standardized pharmacy quality measures and would address “clawbacks.”