NCPA: In New Part D Rule, CMS Asserts Authority to Apply DIR at Point Of Sale

ALEXANDRIA, Va., April 3, 2018 /PRNewswire-USNewswire/ -- In a thousand-page final 2019 Medicare Part D rule released Monday afternoon, the Centers for Medicare & Medicaid Services asserted its statutory authority to require that some portion of rebates and pharmacy DIR fees be applied at point of sale. The final rule stops short of actually requiring such a change, instead stating that "any new requirements regarding the application of rebates at the point of sale would be proposed through notice and comment rule-making in the future."

CMS' recognition of the need to address the issue at all is largely the result of NCPA's forceful lobbying and input. "In this rule, CMS hints strongly that it is concerned about retroactive pharmacy DIR, that it has the statutory authority to address the issue, and that there may be further rule-making to deal with it in the months ahead," said NCPA CEO B. Douglas Hoey, Pharmacist, MBA. "That's very promising. This rule simply telegraphs the next step in the process."

During the comment period on the proposed rule, NCPA led efforts to impress on CMS and the Trump administration the importance of addressing retroactive pharmacy DIR fees. In addition to face-to-face meetings with the White House Office of Management and Budget, Department of Health & Human Services, and CMS officials, the association organized a letter of support from 80 U.S. Representatives and 21 U.S. Senators supporting CMS' proposal to address the unpredictable fees. NCPA also encouraged formal input from pharmacy stakeholders, resulting in more than 1,000 comments in support of the proposal.

The final rule also reflects NCPA's input on a handful of other Part D issues important to community pharmacists, including:

• Any willing pharmacy: Although Part D plan sponsors may continue to tailor their standard terms and conditions for various types of pharmacies, the final rule clarifies that Part D plan sponsors may not exclude pharmacies with unique or innovative business or care delivery models from participating in their contracted pharmacy network simply on the basis of not fitting in a Part D plan sponsor's particular pharmacy type classification.
  
  
• Treatment of accreditation: The rule clarifies that Part D sponsors cannot limit dispensing of certain drugs (such as "specialty" drugs) or drugs for certain disease states to a subset of network pharmacies if a pharmacy is capable of and appropriately licensed under applicable law(s) and agrees to meet the sponsor's standard terms and conditions.
  
  
• Standard terms and conditions: The final rule requires Part D plan sponsors to develop standard terms and conditions and make them ready for distribution by September 15^th. Part D plans must provide the applicable standard terms and conditions to a requesting pharmacy within seven business days of receipt of request.

The final rule also implements statutory provisions of the Comprehensive Addiction and Recovery Act of 2016. Regarding prescriber and pharmacy "lock-in" programs, NCPA agrees with CMS' decision to ensure plan sponsors consider beneficiary preference. NCPA urges CMS to remain vigilant in ensuring appropriate patient access. 

"There's a lot in this final rule to like. We look forward to working with CMS on the additional rule-making necessary to shift onerous pharmacy DIR fees to point of sale," said Hoey. "Doing so will lower costs for taxpayers – as much as $3.4 billion over ten years according to Wakely Consulting Group. That's why we also continue to work toward a legislative solution to the problem via the "Improving Transparency and Accuracy in Medicare Part D Drug Spending Act," S. 413 / H.R. 1038, which would prohibit Medicare Part D plan sponsors and PBMs from retroactively reducing payment on clean claims submitted by pharmacies under Medicare Part D."

The National Community Pharmacists Association represents the interests of America's community pharmacists, including the owners of more than 22,000 independent community pharmacies. Together they represent an $80 billion health care marketplace and employ more than 250,000 individuals on a full- or part-time basis. To learn more, go to www.ncpanet.org, visit facebook.com/commpharmacy, or follow NCPA on Twitter @Commpharmacy.

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SOURCE National Community Pharmacists Association