CMS proposes DIR fee reform

The Centers for Medicare and Medicaid Services (CMS) released a proposed rule that includes provisions for DIR fee reform.  The “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses” seeks to provide transparency in drug pricing.

The proposal would redefine “negotiated prices” under Part D to mean “the lowest amount a pharmacy could receive as reimbursement” and add a definition for “price concession” to include “all forms of discounts and director indirect subsidies or rebates that serve to reduce the costs incurred under Part D plans by Part D sponsors.”

CMS is also considering the development of a standard set of metrics that contract would be based on and is seeking feedback on how to provide more reimbursement predictability while still allowing plans to negotiate terms.

CMS said that the proposed rules could be implemented as soon as 2020.