U.S. Sen. Ron Wyden (D-OR) voiced his support for a proposed new rule by the Centers for Medicare & Medicaid Services (CMS) that would address high fees imposed on pharmacies by pharmacy benefit managers (PBMs).
The proposed rule would require all direct and indirect remuneration (DIR) fees to be applied to lower the cost of a drug at the point of sale. This would reduce beneficiary out-of-pocket costs by $21.3 billion over 10 years. Further, it would allow pharmacies additional transparency around the maximum fees they may be charged by Part D plans and PBMs, allowing them to better plan for and address the financial impact on them of such fees.
“This proposed rule is an important step towards easing the financial strain on thousands of independent pharmacies and millions of Medicare beneficiaries across the nation,” Wyden, chair of the Senate Finance Committee, said. “By constraining these out-of-control fees and requiring additional transparency, this action will help communities that count on these businesses for access to medicine and quality local service.”
DIRs are a form of retrospective fees imposed on pharmacies by PBMs, which have posed a particular challenge for pharmacies to maintain healthy finances. PBMs increased pharmacy DIR fees under Medicare Part D by 91,500 percent from 2010 to 2019, according to a report by the CMS.
Wyden has also called on the Federal Trade Commission to investigate DIR fees and their effects on pharmacy consolidation and closures.