‘This is an emergency’: Trade group warns nearly a third of all independent pharmacies will go extinct because of a CMS rule

Nearly a 3rd of independent pharmacies are astatine consequence of going retired of business owed successful portion to a caller norm from nan Centers for Medicare and Medicaid Services (CMS) that results successful little medicine reimbursements, according to nan National Community Pharmacists Association (NCPA), a waste and acquisition group that represents much than 19,400 US pharmacies.

“This is an emergency,” NCPA CEO B. Douglas Hoey said successful a statement. “If Congress fails to enactment again, thousands of section pharmacies could beryllium closed wrong months and millions of patients could beryllium stranded without a pharmacy.”

The CMS rule, which went into effect connected January 1, requires payers and pharmacy use managers (PBMs) to use what’s called nonstop and indirect remuneration (DIR) fees astatine nan clip a diligent picks up a prescription.

CMS created DIR fees to relationship for nan costs of a Medicare Part D supplier aft it’s dispensed to a diligent and each rebates are taken into account. Historically, a drugstore could beryllium charged a DIR interest months aft dispensing a drug. But nether nan caller rule, payers and PBMs must use each DIR fees astatine nan clip a supplier is dispensed.

The norm is intended to summation supplier value transparency for pharmacies and patients alike, according to nan NCPA. CMS officials said successful December 2023 that nan norm “is expected to little full beneficiary out-of-pocket costs [and] supply meaningful value transparency.”

NCPA execs said successful a connection that nan statement supports nan rule, though it has warned CMS that nan modulation to applying DIR fees up beforehand could make things difficult for independent pharmacies because it results successful little up-front reimbursements rates.

“With little medicine reimbursements successful 1 area and higher back-end fees successful nan other, galore organization pharmacists are reasoning astir throwing successful nan towel,” NCPA execs wrote successful a statement.

The NCPA surveyed 10,000 independent drugstore owners and managers astir nan CMS norm successful February, and of nan 815 respondents, 32% said they’re considering closing down this twelvemonth owed to nan financial constraints. Additionally, 93% said they’d see dropping retired of Medicare Part D adjacent year, and 99% said their medicine reimbursements person decreased since nan norm went into effect.

“If a 3rd of each organization pharmacies close, and if much than 90% extremity accepting Medicare Part D, it will beryllium a catastrophe for seniors, a hardship for astir different patients, and a devastating rustle to nan wide healthcare system,” Hoey said successful a statement.

Independent pharmacies person made CMS alert of nan reimbursement issue, and nan agency sent a missive to payers and PBMs successful December 2023, urging them to “work pinch providers and pharmacies to alleviate these issues and safeguard entree to care.”

“Pharmacies service a captious domiciled successful delivering healthcare and providing entree to medications crossed nan country,” nan missive read. “CMS is concerned astir nan sustainability of these businesses, particularly mini and independent pharmacies, and their imaginable closures that whitethorn time off drugstore services retired of scope for galore people, particularly those successful agrarian and underserved areas.”

The NCPA sent a missive to CMS successful February saying that nan agency’s guidance “has not resulted successful immoderate meaningful alteration successful PBM practices aliases reimbursements,” and urged nan agency to “thoroughly analyse PBM reimbursement practices.”

“More decisive and nonstop action is required from CMS, which is responsible for enforcing programme rules. This should impact clear directives that adjacent nan gaps that let PBMs and plans to enforce unreasonable position and conditions,” Hoey wrote successful nan letter. “This focused attack is basal to support equitable healthcare, particularly successful determining reimbursements. Unless CMS acts quickly, NCPA fears beneficiary entree to drugstore services will beryllium progressively threatened, pinch independent pharmacies being forced to close.”

This article was initially published by Healthcare Brew, a branch of Morning Brew.