Press Releases

Representative Earl L. "Buddy" Carter (R-Ga.), along with Representatives Peter Welch (D-Vt.), Doug Collins (R-Ga.), Vicente Gonzalez (D-Tx.), John Rose (R-Tn.), and Raja Krishnamoorthi (D-Il.) led 115 members of the United States House of Representatives in a request to House and Senate Leadership to provide relief for pharmacies facing clawback fees as they work to serve patients during the pandemic. The bipartisan push requests that language to permanently prohibit pharmacy direct and indirect remuneration (DIR) clawback fees by pharmacy benefit managers (PBM) is included in a future coronavirus relief package. 

DIR fees are imposed after the point of sale of a drug by the PBM on the pharmacy. This arbitrary figure can be collected years after the sale of a drug. Currently, pharmacies have no way of calculating their DIR fees from PBMs or when they might be imposed.

These fees can push the processing cost of the prescription past the acquisition cost, meaning pharmacies lose money on every prescription they fill. The fees also have a direct impact on patients as they pay their co-pays on the higher drug costs.

In the request to leadership, the members wrote, "pharmacies are facing unprecedented demand as they are considered essential providers during this emergency and as patients seek extended supplies of medication. Pharmacies are having to monitor for drug shortages and work with the supply chain to anticipate and proactively address any concerns. Our pharmacies are working round the clock to support patients and protect them from avoidable emergency room visits while our medical system is at maximum capacity. While pharmacists will continue to support their patients access and adherence to medication, we cannot forget that prior to the pandemic, the pharmacy community was already facing extreme financial strain. Many of our districts have seen a wave of pharmacy closures, with more than 2,000 community pharmacies lost over the last two years. We cannot afford more closures as we grapple with a national pandemic and need to protect patient medication access.

Ensuring the viability of our nation’s pharmacies has never been more important. As negotiations on the next aid package move forward, we respectfully request that you remove the barriers that threaten pharmacy financial stability and a pharmacy’s ability to support patients. This can be achieved by enacting much needed pharmacy DIR clawback reform. Pharmacies report that DIR clawback fees continue to be assessed against them right now, even during this period of intense strain. CMS states that DIR fees grew by 45,000 percent between 2010 and 2017, and now, during this financial crisis in which pharmacies are already struggling, DIR fees threaten to cause more pharmacies to close their doors.

We must keep pharmacies open during this crisis."

Click here for the full request. 

According to the National Community Pharmacists Association, 66 percent of independent pharmacies are experiencing negative cash flow issues such as DIR fees, decreasing reimbursement, and coronavirus-related expenses. Pharmacies are paying more for inventory and clawback fees, which makes it difficult to stay in business. Half of pharmacy owners reported paying more than $10,000 in pharmacy DIR fees since March 1. If this pace continues, the average independent pharmacy will be on track to have over $100,000 clawed back in the next twelve months.