Many
Iowans rely on a pharmacist who operates independently or as part of a small
community-pharmacy chain. This is especially true in rural Iowa.
We
have over 300 independent pharmacists practicing in our state and many work in multiple
rural communities.
These
are small businesses serving Iowa communities like Muscatine and Sioux City.
These
pharmacies want a level playing field to compete with anyone, whether that is a
big chain or another independent pharmacy.
Yet,
pharmacists I hear from are being hurt by retroactive DIR fees by PBMs and Part
D plans. These are sometimes known as clawbacks.
When
a senior goes to the drug store, they pay a co-pay.
They
believe they are paying the lowest amount possible.
That’s
not always the case.
After
the patient pays and leaves the pharmacy, their Part D plan or a PBM contacts
the pharmacist to claw back a certain amount paid, called a DIR fee.
This
action actually lowers the cost of the drug, but the patient doesn’t know it.
Because
of these DIR fees, seniors pay more than they need to at the pharmacy.
One
Iowa rural pharmacist told me: DIR fee clawbacks are not only costing the
patient more in the form of a higher co-pay they are also costing the pharmacy.
From
2010 to 2020, Part D plans and PBMs increased DIR fees by over 104,000
percent.
Pharmacists
– especially those operating independently in rural Iowa – have told me: if DIR
fee clawbacks do not get under control, pharmacies will not survive.
Some
have already gone out of business.
This
will leave Iowans without access to a local pharmacy for medication therapy
management or other care.
I
have a bipartisan solution to solve this problem that ends DIR fee clawbacks.
