Pharmacy Law

Pharmacy Law Related Articles

New Jersey Pharmacists Are Given New Tools in the Form of an Old Drug to Combat Opioid Overdoses

Hot Topics in Specialty Pharmacy Law: PBM Prescription Trolling, HUB Arrangements, DIR Fees Update, Opioid and Naloxone Laws, and NADAC Pricing

PHARMACY AUDIT ALERT: CVS Caremark Takes Aggressive Position Against Pharmacies for Purchases from “Unauthorized” Drug Distributors

Express Scripts Leverages Limitations on Pharmacy Practice to Terminate Network Pharmacies

Exploring Pharmaceutical Manufacturer and Specialty Pharmacy Relationships: What You Can and Cannot Do

The Impact of DIR Fees on 340B Relationships Between Contract Pharmacies and Covered Entities

White Paper: "Performance" Based DIR Fees: A Rigged System with Disparate Effect on Specialty Pharmacies, Medicare Part D Beneficiaries and the U.S. Healthcare System

The 21st Century Cures Act: Its Impact on Home Infusion and How Providers Can Respond

Two States Enact PBM Licensure Requirements

PHARMACY ALERT: Roche Begins Issuing Demand Letters Seeking Repayment for Test Strips Claims

White Paper: “Performance” Based DIR Fees: A Rigged System with Disparate Effect on Specialty Pharmacies, Medicare Part D Beneficiaries and the U.S. Healthcare System

In this White Paper, the National Association of Specialty Pharmacy (NASP) and Frier Levitt explore the disparate impact that certain Pharmacy Benefit Managers (PBMs) “Direct and Indirect Remuneration” fees (commonly known as “DIR Fees”) have on specialty pharmacies, Medicare beneficiaries and the healthcare system at large. It examines how some PBM-imposed DIR Fees, often calculated on a percentage of the total cost of the medication, have had a disparate impact on specialty pharmacies that focus on dispensing complex and high cost medications, that often require additional clinical and patient services. Specialty Pharmacies face a “double whammy” when percentage-based DIR Fees are calculated based on “quality metric” categories that have nothing to do with the products and services provided by specialty pharmacies, and over which specialty pharmacies have no ability to influence performance scores. Without a change to the existing practice, specialty pharmacies dispensing critical and complex medications may be unable to provide the support services necessary to ensure clinical success of Medicare Part D and Medicare Advantage patients treated with specialty medications and biologics, ultimately limiting beneficiary choice and access to medications, and resulting in poorer clinical outcomes and increased costs to the healthcare system.

The Centers for Medicare & Medicaid Services (CMS) agrees, DIR Fees have the effect of shifting financial liability from PBMs and Part D Plan Sponsors to beneficiaries, and ultimately the Medicare program, through higher point-of-sale prices, despite the fact that the PBM claws back a portion of the price from the pharmacy. In addition, by rendering specialty pharmacies wholly underwater and forcing them to lose money on every single Medicare claim, PBMs and Part D Plan Sponsors will make it difficult for specialty pharmacies to continue to provide the patient access and clinical support services necessary to ensure optimal clinical outcomes, leaving the sickest patients with few alternatives for their life-saving medications.

As a result of DIR Fees’ impact on Specialty Pharmacies throughout the country, members of the media and the pharmacy industry have begun scrutinizing PBMs and the practice of assessing DIR Fees. The United States Senate and House of Representatives have each introduced proposed legislation aimed at addressing DIR Fees and CMS has issued reports commenting on the impact DIR Fees have on the Medicare program and Medicare beneficiaries. More can and must be done to curtail the assessment of DIR Fees, however, or else patients and taxpayers alike will continue to suffer.

Download the “‘Performance’ Based DIR Fees: A Rigged System with Disparate Effect on Specialty Pharmacies, Medicare Part D Beneficiaries and the U.S. Healthcare System” White Paper for free now by filling out the form below:


 

 

Subscribe

 

Copyright © 2017, Frier Levitt, LLC. All rights reserved. All content of this blog is the property and copyright of Frier Levitt, LLC and may not be reproduced in any format without prior express permission. Contact us for more information or to seek permission to reproduce content. This blog is intended for general information purposes only. It does not constitute legal advice. The reader should consult with knowledgeable legal counsel to determine how applicable laws apply to specific facts and situations. Blog posts are based on the most current information at the time they are written. Since it is possible that the laws or other circumstances may have changed since publication, please contact us to discuss any action you may be considering as a result of reading this blog.