Following up on last week’s NACDS RxIMPACT outreach to the Senate on direct and indirect renumeration (DIR) fee reform, this week the NACDS RxIMPACT grassroots advocacy program mobilized pharmacy advocates to urge members of the House of Representatives to send a letter, led by Rep. Morgan Griffith (R-VA) and Rep. Peter Welch (D-VT), urging action by Secretary of Health and Human Services (HHS) Secretary Alex Azar on DIR fee reform. The letter describes the negative effects on Medicare patients and on pharmacies of the rapid expansion of the use of DIR fees in recent years.

NACDS RxIMPACT advocates coalesced swiftly, generating more than 1,000 letters that reached 152 members of the House of Representatives. The mobilization of pharmacy advocates last week urging Senators to sign a letter—led by Sen. Shelley Moore Capito (R-WV) and Sen. Jon Tester (D-MT)—urging support for DIR reform to HHS Secretary Azar has led to 21 Senators signing on.

In other news regarding DIR fee reform, NACDS this week sent comments to Health and Human Services Secretary Alex Azar in response to the agency’s request-for-information on drug-pricing public policy issues. DIR fee reform figured prominently in NACDS’ comments.

DIR fees were originally intended to capture and report rebate amounts paid by manufacturers at the end of the plan year during the reconciliation process in Part D. In recent years, however, the fees have become a catch-all category used increasingly by payors to include various pharmacy price concessions, such as fees related to performance-based programs or fees for participation in a preferred network. As a result, pharmacies find themselves in the untenable position of being paid by plan sponsors for prescription services, only to find out later that some of the payment must be returned.

DIR fee reform is part of the NACDS Access Agenda, which describes NACDS’ issue positions based on pharmacists’ experiences on the frontlines of healthcare delivery. The NACDS Access Agenda includes efforts to defend patients’ access to care, to improve access to newer services, and to foster safer and stronger communities.