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Jul 29 2021

Pharmacy Leaders Cite DIR Fees and Continuation of COVID-19 Authorizations in Meeting with HHS Secretary Becerra

In mid-March, when Xavier Becerra was confirmed by the U.S. Senate to lead the U.S. Department of Health and Human Services, the National Community Pharmacists Association (NCPA) issued a congratulatory statement, noting Becerra's history of standing up for independent pharmacies while serving as attorney general of California. "We are grateful for this support and are eager to work with him and others in the Biden administration," NCPA CEO B. Douglas Hoey said.

Three months later, in late-June, Hoey, was among a group of pharmacy industry representatives who met with Secretary Becerra to share thoughts about the current landscape, and deliver a list of four specific federal priorities. According to NCPA, that list includes:

  • DIR Fees. Eliminating retroactive price concessions known as pharmacy DIR fees, which are imposed on pharmacies by pharmacy benefit managers, has long been a top pharmacy priority. According to the Centers for Medicare & Medicaid Services (CMS), DIR fees increased by a shocking 91,500 percent between 2010 and 2019. Hoey put this increase in context, noting that if a $4 gallon of milk increased by that much, it would cost $3,660. DIR fee reform has long been a top pharmacy priority, with multiple unsuccessful attempts to address the issue both through federal legislation and regulatory reform. In January 2021, NCPA and other pharmacy groups sought judicial relief, by filing a lawsuit, NCPA v. Becerra, in federal court.
  • "Temporary" COVID-19 Authorizations. Revisiting the temporary authorizations granted to pharmacies during the COVID-19 pandemic, so that pharmacists have permanent authorization in every state to administer tests and vaccinations under Medicare & Medicaid Services.
  • Medicare Part D Reporting Requirements. Maximizing Medicare Part D reporting requirements on pharmacy performance standards.
  • Medicare Part D for At-Home Services. Developing Medicare Part D plan guidance for medical-at-home pharmacy services, so long-term care pharmacists can deliver the same type of in-home services they currently deliver to nursing home patients.


Apparently not included on the list delivered to Secretary Becerra was the critical issue of federal provider status recognition, which allow pharmacists to be reimbursed by Medicare Part B for patient services. Federal provider status is the pharmacy industry's top legislative priority, with bills introduced in both the U.S. House of Representatives and the U.S. Senate, H.R. 2759/S.1362.

Pharmacists clearly have a full plate in seeking to address issues that affect their ability to serve patients, receive payment for those services, and stop the arbitrary claw back of exorbitant amounts of fees.

Pharmacists can be assured these messages were delivered. Whether or not Secretary Becerra will be responsive to this list of concerns though, remains to be seen.