NCPA Beltway TV Buy Pushes Congress to End Backdoor PBM Fees

Ad complements NCPA’s multipronged efforts to end DIR

NCPA December 8, 2021

ALEXANDRIA, Va. (Dec. 8, 2021) – The National Community Pharmacists Association is going live in the Washington, D.C. media market with a seven-figure television ad buy urging senators to finalize language to reform pharmacy direct and indirect remuneration fees in Medicare Part D. Pharmacy DIR fee reform, which the Centers for Medicare & Medicaid Services said would save seniors an estimated $7-9 billion, has been the top priority of independent community pharmacists for years. CMS also disclosed that pharmacy benefit managers increased these retroactive fees on pharmacies by 91,500 percent from 2010-2019. For context, a $4 gallon of milk increased by that much would cost $3,660.

“PBMs are gaming the system at the expense of patient access and local pharmacies, and they won’t stop until they’re forced to,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “They’ll continue manipulating our system, operating largely in secret, and concealing their harmful tactics until they are dragged further into the light. Policymakers in states across the country are working to rein them in but unfortunately, despite bipartisan support for change, the federal government has been slow to act. Community pharmacy will keep fighting on all fronts to regulate PBMs and change our health care system so it better supports the patients and programs it’s supposed to serve, but the federal government has to take action to defend seniors and small businesses.”

In a recent survey of independent pharmacy owners/managers, 97 percent stated that they are significantly concerned with the impact pharmacy benefit manager DIR fees are having on their business, and 26 percent said they may close their pharmacy if DIR fees are not reformed.

Click here to view the ad, which will run at least through the end of December. NCPA made a similar push earlier this year with ads appearing in The Washington Post and Politico.

Pharmacy DIR fees are a tool abused by PBMs to claw back reimbursement paid to pharmacies for Medicare prescriptions, often weeks or months after the transaction. As a result, pharmacies are forced to fill Medicare prescriptions often below cost and patients are prematurely pushed into the coverage gap, or ‘donut hole,’ because of pharmacy DIRs artificially inflating the price of their prescriptions at the pharmacy counter.


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