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118 healthcare organizations unite to support bills prohibiting retroactive pharmacy fees

Lack of transparency, lag time in pharmacy being notified of fees create unnecessary burden on pharmacy operations, orgs say.

Jeff Lagasse, Associate Editor

In a display of unity, 118 healthcare organizations have signed letters supporting companion bills in the Senate and House of Representatives that would prohibit retroactive pharmacy direct and indirect fees in the Medicare Part D program.

The demonstration of support was assembled by the National Community Pharmacists Association. Signatories to the letters also include groups representing drug wholesalers, pharmacy buying groups, grocery stores, retailers and major healthcare systems.

According to the letters, pharmacy DIR fees are "often assessed weeks or even months after a prescription has been filled, and prevent pharmacies from knowing at the time of dispensing what their true reimbursement will be for that prescription. The lack of transparency and the significant lag time in the pharmacy being notified about these retroactive fees creates an unnecessary burden on pharmacy operations and makes it very difficult to make decisions for the future."

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Retroactive pharmacy DIR fees also add costs to seniors and the taxpayers who fund Medicare, according to assessments from the Centers for Medicare and Medicaid Services and the Medicare Payment Advisory Commission.

"CMS noted that DIR affects beneficiary cost sharing, CMS payments to plans and pushes patients into and through the coverage gap sooner," the letters read. "Nearly all catastrophic costs are borne by Medicare and these costs have more than tripled since 2010. MedPAC also raised concerns over Medicare Part D DIR in its 2015 report to Congress. Accounting for these fees at point of sale protects the integrity of the Medicare program, ensures beneficiaries are not being overcharged for their medications, and can potentially lower overall costs as fewer beneficiaries reach the catastrophic phase."

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More than 95 healthcare organizations signaled their support in similar letters to the House and Senate last September. Now that the bills have been reintroduced in the new Congress, the number of signatories has climbed to 118.

Twitter: @JELagasse

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