News > Advocacy > NHIA Submits Comments on DIR Proposed Rule

Advocacy News

NHIA Submits Comments on DIR Proposed Rule

March 22, 2022

NHIA submitted comments on a CMS proposed rule: Medicare and Medicaid Programs; CY 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs, which would alter the way pharmacy price concessions, including direct and indirect remuneration (DIR fees), are calculated by pharmacy benefit managers (PBMs). 

According to CMS, the changes outlined in the proposed rule are intended to achieve the goals of meaningful price transparency, consistent application of all pharmacy payment concessions by all Part D sponsors, and to prevent cost-shifting to beneficiaries and taxpayers. In addition, the agency wanted to address an unsustainable increase in DIR fees and the small percentage of price concessions being passed through to beneficiaries at the point of sale. 

While NHIA supports CMS’s efforts to address the abusive practices of PBMs surrounding DIR, the association expressed concerns that unless all pharmacy price concessions are accounted for at the point of sale at the claim level, PBMs could restructure pharmacy fees to circumvent the intent of the proposed rule. NHIA also opposes allowing for an “alternative negotiated price” for drugs in the coverage gap and requests that CMS apply the proposed revised definition of negotiated price consistently throughout the Part D benefit, which would benefit Medicare beneficiaries. 

Read the comments.  

Related Posts

Congressional Spending Bill Falls Short on Home Infusion

The National Home Infusion Association (NHIA) expressed deep concern today regarding the recently proposed government funding bill, which includes major changes to the qualifying criteria for drugs under Medicare’s home infusion benefit but fails to address the underlying flaws that have plagued the program. Without fixing the structure of the benefit, Medicare beneficiaries in need of home infusions for treatment of a variety of medical conditions, including rare diseases, are unlikely to gain access to home-based care.

Read More »

Patient, Stakeholder Groups Urge Congress to Address Medicare’s Failed Home Infusion Benefit

A diverse group of more than 35 patient and stakeholder groups are calling on Congress to address Medicare beneficiary access to home infusion services. In a letter to lawmakers, which brings together stakeholders from across the care continuum, the groups urge congressional leaders to advance the Preserving Patient Access to Home Infusion Act (S. 1976/H.R. 4104) and increase access to home infusion therapy for Medicare beneficiaries.

Read More »