Front Line Pharmacies Struggling to Pay Unfair Clawback Fees Even While Fighting COVID-19, Says NCPA

114 Reps. also support eliminating DIR fees in fresh push for relief

NCPA April 27, 2020

ALEXANDRIA, Va. (April 27, 2020) — As the coronavirus pandemic continues straining small business independent community pharmacies, 114 members of the U.S. House of Representatives are supporting a bipartisan push to include language permanently prohibiting pharmacy direct and indirect remuneration clawbacks by pharmacy benefit managers in future coronavirus relief packages. The letter was led by Reps. Buddy Carter (R-Ga.), Peter Welch (D-Vt.), Doug Collins (R-Ga.), Raja Krishnamoorthi (D-Ill.), John Rose (R-Tenn.), and Vicente Gonzalez (D-Texas).

A National Community Pharmacists Association analysis released last week found that 66 percent of independent pharmacies are experiencing negative cash flow issues such as DIR fees, decreasing reimbursement, and coronavirus-related expenses. That means 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 12 months.

NCPA CEO B. Douglas Hoey said, “Independent pharmacies are stepping up to help their communities through the coronavirus crisis. They are expanding home delivery zones, putting their own health and safety on the line, continuing to provide a paycheck to thousands of workers – quite literally, they are doing more with less as PBMs claw back funds and reimburse prescriptions below the pharmacy’s cost. The majority of neighborhood pharmacies are already experiencing negative cash flow issues and, for their efforts to help through this pandemic, will get a big bill months from now as PBMs come calling for DIR fees. Eliminating these fees and reining in PBMs has never been more vital if pharmacies are to continue operating now and when this emergency passes. Our continued thanks to those policymakers who understand this and are fighting for PBM reform.”


Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing over 21,000 pharmacies that employ approximately 250,000 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