Patient advocacy groups and allies on the direct and indirect remuneration (DIR) fee reform issue—including NACDS member companies, state associations and others—have also joined in sending letters encouraging Health and Human Services Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma to implement DIR reform. In the letters the groups note that the use of DIR fees has increased a staggering 45,000 percent. The groups also point out that this increase has led to higher costs for patients and the government. Increased patient costs make it harder for patients to get their medications, which has the potential to negatively affect medication adherence and, subsequently, patient health outcomes.

The patients’ groups and stakeholders therefore support the recently released Center for Medicare & Medicaid Services’ proposed rule to make changes to DIR that would lower patient costs. The groups stated that reducing out-of-pocket expenses for patients, improving medication adherence and requiring the inclusion of all pharmacy price concessions in the negotiated price for medications will produce greater transparency and help to strengthen the Medicare Part D program.