Sending Office: Honorable Tom Marino
Sent By:
Matt.Powell@mail.house.gov

        Request for Signature(s)

Letter Closes: COB TODAY

Current Signers:
Marino, Loebsack, Roe, Peterson, King(IA), Blum,
Ruppersberger, Bishop(GA), Carter(GA), Russell, Collins(GA)
, Allen, Scott(GA), Barletta,
Gonzales(TX)
, Thornberry, Goodlatte, Biggs,
Lujan Grisham, Cramer, Dent, Hice, Byrne, Gallagher, Davis(IL), Coffman, Duncan(TN), Thompson(PA), Gohmert, Young(IA), Collins(NY), Herrera Beutler,
Desaulnier
, Crawford, Rothfus, Jones, Sessions, Graves(LA), Trott, Higgins(LA), Ferguson, Roby, Comer

Dear Colleague:

We are writing to ask you to join us in sending a letter to Secretary Alex Azar at the Department of Health and Human Services urging action to address the use of fees, including direct and indirect remuneration (DIR) fees, in the Medicare Part D program.

The increasing use of fees in the Medicare program has been a growing concern in recent years. As noted by the Centers for Medicare and Medicaid Services (CMS) in a 2017 Fact Sheet, and more recently in a Medicare Part D proposed rule, the increasing use
of fees is leading to an increase in beneficiary cost-sharing and payments made by Medicare.  Not only does the use of such fees impact the Federal government and beneficiaries, but the unpredictable variability in the use of fees provides little visibility
for participating retail pharmacies, particularly for performance-based fees and the goals necessary to achieve specified targets to “earn back” fee amounts.

CMS is taking steps to address this concern.  As a part of the proposed rule, CMS included a request for information (RFI) on a potential proposal that would require all pharmacy price concessions, or DIR, be included in the negotiated price.  This is the
price that is used to determine a beneficiary’s out-of-pocket costs at the point-of sale. Last week, CMS finalized the Part D rule.   While the final rule did not move forward on the proposal included in the RFI, CMS indicated that they continue to evaluate
the proposal for future rulemaking.

Our letter highlights how restructuring pharmacy price concessions as detailed in the RFI could lead to lower out-of-pockets costs for beneficiaries and how greater transparency in the use of fees will make medicine more accessible, leading to greater adherence
and better health outcomes.  The letter also urges the Secretary to explore other related policies that promote a quality-driven healthcare system, such as 1) a meaningful and consistent pharmacy-specific performance-based incentive program calculated separate
and apart from the negotiated price, and 2) placing a cap on performance-based fees on a per script basis, thereby limiting the amount of performance fees that can be collected related to a specific drug to facilitate greater transparency and predictability.

We urge you to join us in sending this letter to Secretary Azar. If you have any questions or would like to sign on, please contact
Matt.Powell@mail.house.gov in Rep. Marino’s office or
Katie.Murray@mail.house.gov in Rep. Loebsack’s office.

 

Sincerely,

 

 

Tom Marino                                                                           David Loebsack

Member of Congress                                                            Member of Congress

 

The Honorable Alex Azar

Secretary

United States Department of Health and Human Services

200 Independence Avenue, SW

Washington, D.C. 20201

 

Dear Secretary Azar:

 

We, the undersigned members of the House of Representatives write to urge you to take action to lower prescription drug costs in the Medicare Part D program by reforming pharmacy direct and indirect remuneration (DIR) fees to reduce beneficiary cost-sharing.  

 

In the Medicare Part D proposed rule it issued last fall, the Centers for Medicare & Medicaid Services (CMS) included a request for information (RFI) on potential proposals to require all pharmacy price concessions be included in the negotiated price – the
price used to determine a beneficiary’s out-of-pocket costs at the point-of sale.  In the recently released final rule, CMS stated that it continues to review all input received from stakeholders and that any new requirements regarding the application of rebates
at the point of sale would be proposed through notice and comment rulemaking in the future.

 

The unpredictable variability in the use of fees provides little visibility for the Medicare program, as well as for participating retail pharmacies, particularly for performance-based fees and the goals necessary to achieve specified targets to “earn back”
fee amounts.  

 

We believe restructuring pharmacy price concessions as detailed in the RFI could lower out-of-pockets costs for beneficiaries by lowering the negotiated price of a drug.  The negotiated price of a drug is used to determine a beneficiary’s cost-sharing amount. 
Including all pharmacy price concessions in the negotiated price could also lead to greater transparency in the use of fees and make medicine more accessible, leading to greater adherence and better health outcomes. 

 

In addition to the proposal contained in the RFI, CMS should be looking at other related policies that promote a quality-driven healthcare system.  This includes a meaningful and consistent pharmacy-specific performance-based incentive program calculated
separate and apart from the negotiated price.  Such a program should be based on standardized, achievable and proven criteria that actually measure pharmacy performance.  CMS should also explore placing a cap on performance-based fees on a per script basis,
limiting the amount of performance fees that can be collected related to a specific drug to facilitate greater transparency and predictability.

 

We appreciate your thoughtful consideration of this request and remain hopeful you will take action to lower prescription drug costs in the Medicare Part D program with these reforms.  

.

 

Sincerely,

Related Legislative Issues

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