April 8, 2020 

APRx, TPBC Urge CMS to Grant Relief 
on DIR Fees & Performance Metrics

As always, check our COVID-19 RESOURCE CENTER
at  https://www.aprx.org/home/covid-19-resource-center 
for constantly updating news, guidelines & resources.

In a letter sent Monday to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, American Pharmacies and Texas Pharmacy Business Council recommended substantial changes in CMS rules governing the DIR fees assessed by PBMs in Medicare Part D plans and how the performance measures that drive them are defined and applied.

Our proposals were submitted in response to CMS's request for stakeholder input on its proposed rule to establish standards to govern Part D sponsors' assessment of DIR fees on network pharmacies. The letter noted that "While the proposed rule is an important step forward, it does not adequately address the inherent problems with performance-based compensation arrangements."

Our letter urged CMS to:
  • Establish a single set of uniform, objective and verifiable metrics for all Part D plans to use in measuring their pharmacy providers.
  • Prohibit any DIR fee system that automatically penalizes all pharmacies, even those that meet the highest stated performance standards.
  • Require that any metrics are achievable and not "graded on a curve." (For example, a pharmacy that meets the highest standards should be categorized as top-performing and not be excluded because it is not part of the top 1%.)
  • Limit performance-based pharmacy price concessions to a deduction from or addition to the dispensing fee, not the medication cost.
  • Require that performance-based compensation incentives and penalties applied to pharmacy claims be tied directly to the metric being measured. (PBMs often deduct penalty amounts from a pharmacy's claims on all drugs, not just the ones in the specific therapeutic category being measured for adherence.)  
  • Limit performance-based compensation metrics to measurement of individual pharmacy performance only and not measurement of a group of unrelated pharmacies. 
  • Define price concessions to include all fees a Part D plan sponsor charges its network pharmacies, including transaction, network and other fees. 
High Court Postpones Oral Arguments in Landmark PBM Case

On April 3, the U.S. Supreme Court officially postponed oral argument in the landmark Rutledge v. PCMA case as a result of the COVID-19 crisis.  The Rutledge case had been originally scheduled to be heard April 27.  The Court did not state whether it will rule on the case before the current term ends in June, or whether it will defer oral argument until the fall.  
At issue in the Rutledge case is whether federal ERISA law pre-empts a 2015 Arkansas PBM reform law. PCMA has argued that Arkansas' law, as well as other state PBM-reform laws across the country, are not enforceable because they are pre-empted by federal ERISA law. If the U.S. Supreme Court sides in favor of Arkansas, it will vastly increase the ability of states to regulate multiple aspects of PBM operations.

Make Sure Your Community Knows You Are Hanging Tough!

We know that all of you out there are working through challenging conditions to continue serving your patients and your communities. And you all are deserving of the public's praise and appreciation for your efforts. 

APRx Board Member Mike Muecke's crew at the Palacios Prescription Shoppe in Palacios, Texas, got a nice shout-out (at left) from their local weekly newspaper, the Palacios Beacon, in today's issue. Many more of you must be getting this type of recognition, so please share it with us by sending a photo of or link to the article/photo. 

An easy way to get publicity from your area media is to send a photo of your pharmacy staff to your local newspaper or television station along with announcement that you are still in business to serve the community. Be sure to tell the media outlets what your hours and prescription fill procedures are during the pandemic and if you are delivering and/or mailing medications. It's important information that they should share with the community in the interest of public health, and you'll get some recognition out of it. You could also use the opportunity to share important facts about the pandemic, medications or personal protection. 

If you're doing something noteworthy -- like making your own hand sanitizer and giving it away to first responders in your community -- make sure the media know about that, too.

Getting the word out that you are still open for business and proving a badly needed health service in your community is important. And there's nothing wrong with building your visibility and public image in the process. Please let us know how it's going by share your Facebook posts, photos and media clipplings/links with our marketing & communications team: