Are Specialty Pharmacies Unfairly Charged DIR Fees?

The Pharmaceutical Care Management Association (PCMA) has countered reports on the potential harm that DIR fees can have on patients. PCMA said in a previously issued press release these fees help to lower premiums overall.
“DIR reduces premiums for Medicare Part D beneficiaries, which leads to lower costs for the federal government. Stable and affordable premiums contribute to a 90% satisfaction rate among Part D enrollees for their drug plan,” PCMA said in a press release.
Going forward, Agostino advocates for enlisting the help of CMS to create clarity around specialty pharmacies, and create appropriate performance standards. Although the ultimate goal is to eliminate DIR fees, creating standards can, in theory, reduce DIR fees unfairly charged to specialty pharmacies. Specialty pharmacy-specific standards may also help the pharmacy perform well in value-based contracts.  
“It benefits the plan by way of offering appropriate oversight, clinical management, and it also benefits the patient,” Agostino told SPT. “If that were to happen, then we have an opportunity to see where programs can be created to incentivize specialty pharmacies to want to be and maintain their best in class performance measurements. Right now we don’t have that.”
Improving performance measures is a short-term way to ensure that independent specialty pharmacies are able to stay in business, and provide necessary medical care to their patients.
While pharmacies and advocacy organizations have spoken out against DIR fees, PBMs and their associations have responded that the fees do not harm patients or the profitability of pharmacies.
However, Agostino told SPT that pharmacists must get involved in the conversation, and make sure that legislators are informed about how DIR fees can be detrimental to the health care industry.
“NASP, as an organization, is incredibly engaged. We hear our members loud and clear. As I have said to members before, get involved and speak up. Get to know your local Congress representatives, invite them to your specialty pharmacies, share with them what you do and how you take great care of patients, and explain to them that the business model that has been created within specialty pharmacy is a direct reflection on the type of critical care patients need with very advanced medications that are coming out,” Agostino said. “In order to stay relevant, we need to make sure that we’re doing the best that we can in educating our government officials as to the value of what we’re doing and to effectively come together and to show outcomes and those outcomes translate into the valve that we deliver.”
Education is a key factor, Agostino said. If lawmakers and government officials, such as CMS, are uneducated about specialty pharmacies, they may not fully understand how DIR fees can impact care for patients who require complicated treatments.
The more education government officials have regarding DIR fees, the more likely DIR fees can be fairly evaluated, which is the overall goal of those who oppose this PBM action. 
“It is our hope that we can see the industry continue to band together and educate our government officials to continue to have impact at CMS,” Agostino concluded. “We need to continue to work collaboratively with CMS directly to help them understand the value of what we’re providing, and allow them to ask questions that can help them measure the success points of quality patient care within a specialty pharmacy.”

 Editor's Note: Specialty Pharmacy Times provides balanced and fair coverage to both sides of the direct and indirect remuneration issue and does not advocate a position, but instead provides a platform for various stakeholders to express their viewpoints.

Stay up to date on the latest news in specialty pharmacy by getting Specialty Pharmacy Times in your mailbox or inbox for free!

Click here to sign up for free for the bi-monthly Specialty Pharmacy Times print journal delivered to your address.

Click here to sign up for our email newsletters delivered every Monday, Wednesday, and Friday, in addition to breaking news alerts.

Click here to follow us on Facebook. 

Click here to follow us on Twitter. 

Click here to join our LinkedIn group. 

Related Articles

Top news of the day from across the health care landscape.
Top news of the day from across the health care landscape.
Top news of the day from across the health care landscape.
Company Profile >
Industry Guide >
Market News >
Peer Exchange >
Conferences >
Subscribe >
Specialty Times Resources
About Us
Contact Us
Terms & Conditions
MJH Associates >
Pharmacy Times
American Journal of Managed Care
MD Magazine
Targeted Oncology
Physicians' Education Resource
Pharmacy & Healthcare Communications, LLC
2 Clarke Drive
Suite 100
Cranbury, NJ 08512
P: 609-716-7777
F: 609-716-4747

Copyright Specialty Pharmacy Times 2006-2019
Pharmacy & Healthcare Communications, LLC. All Rights Reserved.