U.S. Sen. Shelley Moore Capito (R-WV) has joined in leading a bipartisan group of colleagues to support greater transparency, reduce out-of-pocket costs and eliminate certain fees for American seniors’ prescription drugs.
Sens. Capito and Jon Tester (D-MT), along with 19 other senators, signed on to a Jan. 24 letter supporting the Centers for Medicare and Medicaid Services’ (CMS) proposed rule that would require pharmacy drug price concessions to be reflected in the negotiated drug price that seniors pay at their pharmacies. The CMS proposal, released on Nov. 28, 2017, includes proposed revisions to regulations for the Prescription Drug Benefit program (Part D), among a host of other recommended actions toward implementing certain provisions of federal laws and improving program quality, accessibility, affordability and the CMS customer experience.
“Pharmacy price concessions account for real differences between the listed prices of prescription drugs and those drugs’ final, actual costs,” according to the letter senators sent to CMS Administrator Seema Verma. “By requiring that all of these pharmacy price concessions be reflected in the negotiated price at the point of sale, CMS’s proposal will help increase the transparency and accuracy of prescription drug costs in Medicare Part D and help significantly lower American seniors’ out of pocket drug costs.”
U.S. Sens. Bill Cassidy, M.D. (R-LA), Susan Collins (R-ME), Steve Daines (R-MT), Joni Ernst (R-IA), John Hoeven (R-ND), Jerry Moran (R-KS), Thom Tillis (R-NC), and Roger Wicker (R-MS) also signed the letter.
Additionally, the senators support the CMS plan because it would bring down what Medicare beneficiaries pay on their own to buy their prescriptions, in turn reducing financial stressors on seniors who may be living on fixed incomes and protecting them from a Part D coverage gap. “Seniors should no longer have to bear the burden of artificially inflated drug prices when they go to the pharmacy counter,” the senators wrote.
The senators wrote they also were “particularly pleased” that the CMS proposal would prohibit retroactive pharmacy Direct and Indirect Remuneration (DIR) fees.
As the senators pointed out, Medicare Part D sponsors often “claw back” price concessions and assess DIR fees from pharmacies as much as six months after pharmacies have sold and distributed the drugs. The lawmakers noted the financial hardship and uncertainties that Main Street pharmacies and seniors face in such scenarios.
“We have heard from numerous pharmacies in our communities — many of which are rural or medically underserved — that these claw back fees cause so much uncertainty that they do not know if they can continue to serve American families,” according to the letter.
Pharmacies across the nation “do not know when the fees will be collected, how large a fee they will have to pay, and if the final amount they are paid will actually cover the cost of dispensing the drugs,” the senators wrote. “This sort of opacity in the real cost of prescription drugs and the method of paying for them is exactly why Americans are so frustrated when they try to fill a prescription.”
A community pharmacists’ organization welcomed the senators’ support for that aspect of the CMS proposal.
“Thanks to the strong leadership of Senators Capito and Tester, a bipartisan coalition of senators has endorsed CMS’ fix for the problem of retroactive pharmacy DIR fees,” said B. Douglas Hoey, chief executive officer of the National Community Pharmacists Association. “Patients, taxpayers and pharmacies will all benefit from the agency’s transparent, common sense proposal.”
Last February, Capito and Tester introduced the Improving Transparency and Accuracy in Medicare Part D Spending Act, S. 413, to prohibit Medicare Part D plan sponsors and pharmacy benefit managers from retroactively reducing payments on accurately submitted pharmacy reimbursement claims, according to the bill’s summary. It is the Senate version of an identical bill, H.R. 1038, introduced earlier in February 2017 by U.S. Rep. H. Morgan Griffith (R-VA).
S. 413 cosponsors include Sen. Wicker, an original cosponsor, as well as Sens. Moran, Collins and Mike Rounds (R-SD). The bill has been referred to the Senate Finance Committee.