Pharmacy united in call for President Trump to Act on DIR fee reform

APhA and other pharmacy organizations on Monday sent a letter to President Donald Trump calling on his administration to provide relief from pharmacy direct and indirect remuneration (DIR) fees that inflate drug costs paid by patients and the government, and that force pharmacies to fill Medicare prescriptions often below cost.

APhA and other pharmacy organizations on Monday sent a letter to President Donald Trump calling on his administration to provide relief from pharmacy direct and indirect remuneration (DIR) fees that inflate drug costs paid by patients and the government, and that force pharmacies to fill Medicare prescriptions often below cost. "We write to voice our disappointment that the final rule Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses did not address onerous [DIR] fees that have increased 45,000% since 2010, with no savings passed onto beneficiaries," the letter stated. "This number will continue to grow if these practices are not reformed." Members of Congress are currently working on a bipartisan basis to craft and to marshal support for legislation that would accomplish reforms initially proposed, but not ultimately finalized, in the Medicare rulemaking process for 2020. These reforms include addressing the gaming of the system through DIR fees, and working toward pharmacy-specific metrics to enhance patient outcomes and appropriately evaluate pharmacy performance. The pharmacy groups emphasized the extensive support for DIR fee reform during the Medicare rule's comment phase, as expressed formally by "over 3,500 pharmacists, 155 pharmacy stakeholder organizations, more than two dozen patient advocacy organizations, 29 U.S. Senators, and 62 members of the U.S. House of Representatives."