Pharmacists from across the nation will converge in Washington D.C. on April 11 and 12 for the annual NCPA Congressional Pharmacy Summit. It’s a great opportunity to be an advocate for both independent pharmacy and for your patients.
We know the challenges of a prescription delivery market that is so heavily controlled by the PBMs. They determine which pharmacies are included in prescription benefit plans, how much they will be paid, and which drugs will be included in formularies. For independent pharmacies, PBMs are a particular threat: often, they try to persuade insurers to push patients to mail-order pharmacies or to pharmacies owned by the PBM itself—which would seem to be a clear (and actionable) conflict of interest in any other business. Limited networks, typically favoring chains, put patients in rural areas at a disadvantage, sometimes forcing them to drive many miles to access an in-network pharmacy.
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While topics at the NCPA 2017 annual conference ranged broadly, one of the most talked-about themes inside and outside the halls of learning was definitely (and unsurprisingly) DIR fees. (If you missed the event, this will give you a taste that might sway you to attend next year). Let’s face it: pharmacists are beside themselves. Earlier this year, DIR fees were called “legalized theft” in this piece on their connection to Star Ratings. Pharmacies first need to know how the fees are calculated: on a percentage- versus a per-prescription-basis. Then, if there are clinical or operational data that can change the rate (Star Ratings criteria like adherence rates or contract criteria like GDR), pharmacies can impact the fees ultimately charged. Meanwhile, tools like the DIR fee estimator are creating at least more predictability for pharmacies. Ultimately, though, relief may be in legislation. NCPA has made a strong push for the enactment of S. 413 / H.R. 1038, which would prohibit retroactive DIR fees, and many states are pursuing their own versions of transparency bills. Stay tuned.
Here are a few other stories that might be of interest:
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