INSIDE APA
policy world for advancement of pharmacy services. The next year promises to be very exciting to support our great profession in the continued fight to end the pandemic through education and vaccination efforts. We have many new professional opportunities emerging from the recent success of the 2021 state legislative session. We also have a new future home to build for the Arkansas Pharmacists Association to thrive for the next 50 years. This project, The Phoenix Project, promises to provide a better pharmacy home for our profession
to gather, share ideas and advocate for a fair playing field for our profession to thrive. This exciting opportunity emerged from a dark time in our history and offers the chance to grow and rise from the ashes of 2020, with a fresh start at 417 South Victory next to our beautiful state Capitol. I ask for your continued presence, your financial gifts, your professional services, and your relationships with policy makers more than ever for us to succeed in the new land of opportunity. §
FROM THE PRESIDENT
NCPA Files Suit Over DIR Fees: What Could It Mean for Arkansas?
O
n January 15th NCPA filed a lawsuit against the government (HHS) to end retroactive pharmacy DIR fees. This suit is challenging a 2014 CMS rule which created a loophole allowing Part D plans and their PBMs to claw back exorbitant pharmacy DIR fees. Since 2014 NCPA has worked to persuade HHS to adopt new rules to stop DIR fees. We were all hopeful there was a remedy to the problem in 2019 but there was opposition and no solution was given. NCPA CEO Doug Hoey said “We’ve exhausted every effort to work through the legislative and regulatory processes. But we’ve had enough. We can wait no longer.” Retroactive pharmacy DIR fees make it difficult, if not impossible, for pharmacy owners and managers, to know actual costs and be able to plan. The DIR fee is recouped at a much later date (weeks or months) from the point of sale and arbitrary reports make it impossible to reconcile. There is no way to know how much was made or lost on individual Part D prescriptions. Mark Riley, former APA CEO, has been quoted explaining the PBM model as “it's like Visa telling Dillards how much to charge for the sweater.” However, with retroactive DIRs the PBM then months later comes back and pulls out arbitrary fees for DIR bringing the reimbursement below the cost of the drug. There is no way for pharmacies to plan and to control cash flow. No business can operate this way. Also, due to the lack of transparency they conceal the true cost of prescription drugs from the patient, taxpayers, and lawmakers, ultimately driving up the cost of prescription drugs and healthcare. As the pharmacist, you do not even know the true cost of that drug or what you were paid (or not paid) for the drug. On January 28th, NCPA held a webinar to educate pharmacists on the lawsuit. The recording is on the NCPA website. During the
WWW.ARRX.ORG
Kristen Riddle, Pharm.D. APA President
webinar Doug Hoey made the point “DIR was never intended to have seniors, taxpayers, and pharmacy owners be reverse Robin Hoods, suffering while PBMs fill their pockets.” NCPA listed a study in the NCPA v Azar press release showing the increase in DIR fees since 2015 has been 1,600% with $4 billion in DIR fees being taken from pharmacies in 2017 alone. Pharmacists across the nation have felt this increase year after year and many have not been able to weather this storm leaving communities without a local pharmacy and patients without the resources of a local pharmacist. NCPA claims in the suit that the exception which allows DIR claw backs after the point of sale was inserted into a final rule in a manner that violated the legal process for proper rule making (NCPA v Azar Press Release-NCPA website). This exception is the loophole in which Plans and PBMs have used to claw back billions from independently owned pharmacies. “The goal of this lawsuit is to strike down a massive loophole in Medicare rules which Part D plans and their PBMs have used to pocket billions of dollars at the expense of patients and small business community pharmacies.” (NCPA Lawsuit to End DIR Fees- NCPA website) The lawsuit would eliminate retroactive claw backs and put all prescription price concessions at the point of sale. The suit however, would not prevent bad contracts. It will be up to the community pharmacy profession to make sure we have fair contracts. This suit would require re-contracting and give greater transparency and predictability at the point of sale. It is the first step to eliminate DIR all together. I am thankful NCPA has moved forward with this suit because doing nothing is not an option. §
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