Drug Channels published a nice summary of some proposed changes to DIR fees being considered by CMS. Adam Fein’s commentary does a good job summarizing the current challenges faced by both CMS, the patient. and pharmacies. Among the more interesting data he presents: while manufacturers’ rebate payments to Part D plans are the largest component of the DIR pie at $29.5 billion in 2017, pharmacy price concessions (as DIR fees) have increased significantly as a share of total DIR pie, from 1.7% in 2013 to 11.4% in 2017. Of course, this comes as no surprise to anyone running a pharmacy.
Adam’s conclusion to the impact of the proposed changes if enacted:
The outcomes—higher government costs and lower manufacturer payments—create political challenges for point-of-sale pharmacy DIR. Pharmacies will cheer the change, while plans will criticize it. Meanwhile, the patient impact is mixed. An unknown number of patients will benefit from lower out-of-pocket costs, but a possibly larger number of patients will see slightly higher monthly premiums.
Jump to CMS Considers Point-of-Sale Pharmacy DIR: Another Prelude to a World Without Rebates? to read the whole article.