CMS Takes Action to Address Pharmacy DIR Clawbacks That Harm Specialty Patients and Pharmacies

Washington, DC, Jan. 07, 2022 (GLOBE NEWSWIRE) -- On Thursday, the Centers for Medicare and Medicaid Services released a proposed rule that would require Part D plans to apply all price concessions they receive from network pharmacies to the point of sale, so that the Medicare beneficiary can also share in the savings. Specifically, CMS is proposing to redefine the negotiated price as the baseline, or lowest possible, payment to a pharmacy, effective January 1, 2023. This policy would reduce beneficiary out-of-pocket costs and improve price transparency and market competition in the Part D program.

National Association of Specialty Pharmacy President and CEO Sheila Arquette, RPh stated, “For years, rising pharmacy DIR fees under Medicare Part D have been harming specialty patients who are living with life-altering and often times life-threatening medical conditions and the pharmacies that serve them. CMS has a real opportunity to reduce senior drug costs through pharmacy DIR reform, which has manipulated drug costs under Medicare Part D while directly hurting the specialty pharmacies that serve patients with conditions like multiple sclerosis, hemophilia, or cancer.  NASP is grateful for the leadership of Health and Human Services Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure to tackle this decades long problem. We look forward to working with the Administration and Congress to ensure this problem is addressed correctly once and for all.”

CMS states in the rule that pharmacy DIR fees have more than skyrocked, 107,400% between 2010-2020. Pharmacy DIR fees are monies received by pharmacy benefit managers (PBMs) and Part D plans and include concessions pharmacies are forced to pay after, and sometimes up to six months after, they have dispensed medications to seniors. Pharmacy DIR fees result in profit for PBMs/payers while forcing pharmacies to fill Medicare prescriptions below cost.  Reforming pharmacy DIR fees would reduce the amount seniors pay for their drugs when they receive them from a pharmacy.

“We remain committed to working with CMS as it advances pharmacy DIR fee reform to ensure that reforms are transparent, fair and support specialty patients and the pharmacies that serve them. CMS’ proposal indicates that reform could be in place for Contract Year 2023, and it is imperative for patients, market competitiveness and the efficiency of the Medicare Part D program that reform take effect as soon as possible.”

For more information:

A CMS press release is available at: 

The final rule can be downloaded from the Federal Register at:

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The National Association of Specialty Pharmacy (NASP) is the only national association representing all stakeholders in the specialty pharmacy industry.  NASP members include the nation’s leading specialty pharmacies, pharmaceutical and biotechnology manufacturers, group purchasing organizations, patient advocacy groups, integrated delivery systems and health plans, technology and data management vendors, logistics providers, wholesalers/distributors and ​​​practicing pharmacists, nurses, and pharmacy technicians. With over 145 corporate members and 2,000 individual members, NASP is the unified voice of specialty pharmacy in the United States.


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