January 18, 2021


The National Community Pharmacists Association has had enough: It’s suing HHS over DIR fees. Specifically, it’s suing over the exception in Medicare regulations — the loophole, really — that allows PBMs to continue to charge clawbacks to pharmacies filling Medicare Part D prescriptions.

“HHS initially said the exception would address a very narrow set of circumstances,” NCPA wrote, “but instead has opened a ‘Pandora’s box’ for Part D plans and their PBMs.”

Pointing out that DIR fees rose a whopping 45,000 percent between 2010 and 2017, and that calls for reform have been rejected, “a lawsuit challenging the validity of pharmacy DIR fees is necessary to protect the downstream consumers.”

The suit claims that the rule “violates the plain language and intent of Congress when [it] passed legislation creating the Medicare Part D program,” that the rule is arbitrary and capricious, and that it “was not adopted through proper notice-and-comment rulemaking.”

You can read the details of the suit here.