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    Top 7 Challenges (and Opportunities) for Pharmacy in 2018

    What’s the difference between a challenge and an opportunity? In 2018, for pharmacy, they may be the same thing.

     

    Legislation related to DIR fee

    DIR Fees

    Retroactive direct and indirect remuneration (DIR) fees are a growing problem for many pharmacists.

    “Pharmacy benefit managers are pulling money back months down the road,” said Marvin Moore, PharmD, Owner and President of The Medicine Shoppe in Two Rivers, WI. “The toughest part is that DIR fees are not transparent to us. We just get PBM reports saying they have pulled dollars back. You don’t know what factors are being evaluated over what period. It is out of our control.”

    The NCPA and other pharmacy groups have been pushing legislative and regulatory reforms for years and the Centers for Medicare and Medicaid Services (CMS) is listening. CMS’s proposed Part D rule for 2019 calls for pharmacy price concessions to be included in the negotiated price.

    Related article: Battling DIR Fees

    The proposed rule would eliminate retroactive DIR fees for the roughly one-third of prescriptions covered by Part D. The Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, a legislative fix that is stalled in Congress, would ban retroactive DIR fees altogether.

    The CMS change would save federal payers $3.4 billion over 10 years according to a study sponsored by the NCPA. CMS noted that banning retroactive DIR fees would also save patients $10.4 billion and give community pharmacies greater financial predictability.

    “It is hard to dispense a medication and not know your ultimate reimbursement for months,” Moore told Drug Topics. “It would help to have the fees become transparent and even more to have them at the point of sale.”

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    Fred Gebhart, Contributing Editor
    Contributing Editor Fred Gebhart works all over the world as a freelance writer and editor, but his home base is in San Francisco.

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