Happy New Year….. or to be said otherwise, What’s Happy About It?
The article below doesn’t trumpet the benefit of the changes implemented by Congress ‘fixing’ the vexing issue of direct and indirect reimbursement (DIR) fees that grew by 107,000% over the past decade. As specialty pharmacies know all too well, these fees have cut deeply into profit margins….. and there was a glimmer of hope that the new regulations would be the ‘fix’ they were hoping for.
According to the article, PBMs are implementing flanking maneuvers that could be even more onerous than DIR fees.
For example—–
- Express Scripts has sent out contracts announcing that it would pay pharmacies approximately 10% below average wholesale price (AWP), “meaning they could lose money on every prescription they fill.”
- “Specialty pharmacies have been receiving new contracts with even more drastic cuts, as much as AWP minus 20%”
- “Specialty pharmacies have been particularly hard-hit, but I think pharmacies across the board of all types have seen their 2024 contract agreements tank in terms of the rates.”
- “PBMs can continue to claw back fees from pharmacies even with this new rule.”
As the adage goes, winning one battle does not mean that the war has been won.
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PBMs Implement Sweeping Reimbursement Cuts and Ramp Up Audits
