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Rep Krishnamoorthi urges CMS to prevent additional fees to pharmacies
In their letter, the lawmakers emphasized that the implementation of IRA requirements should not place additional financial strain on the nation's pharmacies.
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Congressman Raja Krishnamoorthi, along with colleagues Reps. Donald Davis and Vicente Gonzalez Jr., urged the Center for Medicare and Medicaid Services (CMS) to ensure that plans and pharmacy benefit managers (PBMs) do not impose additional fee charges on pharmacies in the country.
They called on CMS to ensure that the managers do not charge direct and indirect remuneration (DIR) for negotiated drugs available to seniors at reduced prices through the provisions of the Inflation Reduction Act (IRA).
In their letter, the lawmakers emphasized that the implementation of IRA requirements should not place additional financial strain on the nation's pharmacies. They highlighted that the IRA explicitly states pharmacies should not be reimbursed below the "maximum fair price" (MFP) for negotiated drugs.
They expressed concern that pharmacies might be reimbursed below the MFP, particularly if DIR fees are applied to these drugs. They further noted that pharmacy reimbursement should be fair, covering acquisition cost plus margin, and should include a reasonable professional dispensing fee. Currently, PBMs pay retail pharmacies dispensing fees that are significantly below the actual cost to dispense, sometimes as low as $0.
“Pharmacies are already facing significant cash flow concerns in Medicare Part D, and failing to establish protections against DIR fees on MFP drugs or to ensure appropriate pharmacy dispensing fees and prompt payment to pharmacies (as required by the IRA) would exacerbate those concerns. According to a recent survey by the National Community Pharmacists Association, 32 percent of all respondents say they are considering closing their doors in 2024 because of the cash crunch in Medicare,” the letter read.
According to the survey, 93 percent of respondents indicated that they might withdraw from Medicare Part D in 2025 if this year's conditions persist, which would severely impact patient access nationwide, particularly for senior citizens. More than half of the respondents reported that Medicare Part D prescriptions constitute 40 percent or more of their business.
“Pharmacy “deserts” are proliferating in the country, especially in some of the areas where our country’s most socially vulnerable populations reside. In 2023, there were over 300 independent pharmacy net closures — in other words, every day patients have one fewer independent pharmacy from which to choose. Additionally, there are approximately 2,200 fewer retail pharmacies than there were four years ago—an overall 4 percent decrease in pharmacy choices for patients—and that pattern of pharmacy closures is increasing,” the lawmakers said in the letter.
“Based on the most recent data through Feb. 29, 2024, independent pharmacy net closures continue at approximately one store per day. We urge CMS to act to preserve all pharmacy access for seniors by addressing the financial pressures that risk further eliminating access to the pharmacy of their choice,” they added.
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