Congressman Krishnamoorthi Leads Colleagues In Letter Urging Center for Medicare and Medicaid Services To Prevent Pharmacy Benefit Managers From Charging Additional Fees To Pharmacies
WASHINGTON – Today, Congressman Raja Krishnamoorthi led colleagues Reps. Donald Davis (NC-01) and Vicente Gonzalez Jr. (TX-34) in asking that the Center for Medicare and Medicaid Services (CMS) “ensure that plans and pharmacy benefit managers (PBMs) do not charge direct and indirect remuneration (DIR) fees to pharmacies for negotiated drugs” available to seniors at reduced prices through the provisions of the Inflation Reduction Act (IRA).
Implementation of IRA requirements must not result in additional financial pressure and loss for our nation’s pharmacies,” the Members wrote. “The IRA is clear that pharmacies are not to be reimbursed below the “maximum fair price” (MFP) for negotiated drugs. We are concerned that pharmacies will be reimbursed below the MFP, especially if DIR fees are assessed on these drugs. Additionally, pharmacy reimbursement should be reasonable and cover acquisition cost plus margin plus include a commensurate professional dispensing fee (currently, PBMs pay retail pharmacies dispensing fees far below the actual cost to dispense, as low as $0).”
"We have fought hard for years to prohibit retroactive DIR fees, which harm both pharmacies and patients," said B. Douglas Hoey, CEO of the National Community Pharmacists Association. "Finally, at the beginning of this year we started to see relief as CMS's DIR rule went into effect eliminating retroactive fees. However, we now have grave concerns about the continued viability of independent pharmacies if PBMs continue to undercut these small businesses by levying DIR fees on drugs in the Inflation Reduction Act that are assessed a Maximum Fair Price (MFP), contradicting the law's original intent. We are grateful for the leadership of Rep. Krishnamoorthi, as well as Reps. Davis and Gonzalez, in their support for independent pharmacies.”
The letter is available here.