NCPA to Congress: Don’t Pass the Buck on DIR, Spread Pricing Reforms

NCPA November 5, 2021

ALEXANDRIA, Va. (Nov. 5, 2021) – Ahead of expected congressional action on government spending legislation, the National Community Pharmacists Association is expressing disappointment that the House version of the reconciliation bill leaves out provisions to eliminate pharmacy benefit manager retroactive Medicare Part D pharmacy direct and indirect remuneration fees and PBM spread pricing games in Medicaid managed care programs. NCPA has pushed negotiators to include these important provisions, repeatedly emphasizing that pharmacy DIR fee reform would save seniors an estimated $7-9 billion while a ban on Medicaid managed care spread pricing and a move to fair and transparent pharmacy reimbursement would save the federal government over $1 billion.

NCPA CEO B. Douglas Hoey, pharmacist, MBA, issued the following statement:

“For years, PBMs have been playing drug pricing games that contribute to higher drug costs to the harm of the patients and taxpayer-funded programs the PBMs are supposed to serve. While we’re grateful to those community pharmacy allies in Congress who have fought and continue fighting to rein in PBM games like pharmacy DIR fees and spread pricing – and recognizing that there seems to be a long road ahead for this spending legislation – it’s concerning that these critical reforms are currently excluded from the House proposal. We will continue working with our allies in the House and Senate with the goal of including these and other important provisions, like pass-through pricing, in the final package.”

Reps. Peter Welch (D-Vt.), Vicente Gonzalez (D-Texas), Raja Krishnamoorthi (D-Ill.), and Abigail Spanberger (D-Va.) have led the charge in the House to incorporate pharmacy DIR fee reform into the Democrats’ spending package.

Additionally, multiple state Medicaid programs have indicated PBMs are using spread pricing as a way of overcharging taxpayers for their services, with Arkansas, Georgia, Kentucky, Louisiana, Maryland, New Hampshire, New York, Ohio, Pennsylvania, and Virginia prohibiting spread pricing in their Medicaid managed care programs.


Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing nearly 19,400 pharmacies that employ approximately 215,000 individuals nationwide. Community pharmacies are rooted in the communities where they are located and are among America’s most accessible health care providers. To learn more, visit