Arkansas Delegation Supports CMS Proposed Rule Change

February 1, 2019
Press Release

This week, the Arkansas delegation sent a letter to Health and Human Services Secretary Alex Azar, voicing support of the provisions in the Center for Medicare and Medicaid Service’s (CMS) recently proposed rule, Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses, that would reform the use of pharmacy direct and indirect remuneration (DIR) fees, or pharmacy price concessions, in the Medicare Part D program. Delegation members issued the following statements in response:

“Both community and corporate pharmacies are significant parts of Arkansas’s economy, and this proposed rule would relieve their skyrocketing out-of-pocket drug rates. This is a commonsense solution to a systemic problem that affects both pharmacy owners and seniors, and I’m glad to see the entire state delegation supporting these changes. I’m grateful for the Administration’s continued focus on lowering prescription drug rates, and hope to implement positive changes soon." – U.S. Rep. Bruce Westerman (R-Ark.), Fourth District

“Unchecked middlemen should not be allowed to retroactively snatch money from small business owners and the seniors they serve. I applaud the Administration’s efforts to provide access to affordable medications and increase transparency within the Part D program. Arkansas continues to lead on this issue and I look forward to implementation of these necessary changes nationwide.” – U.S. Rep. Rick Crawford (R-Ark.), First District

“The path to lowering the cost of prescription drug prices requires greater transparency and more competition. The proposed CMS rule accomplishes both of these goals and will benefit not just patients but also the 384 independent community pharmacies throughout Arkansas that often serve as the only local health provider in our rural communities. Creating more certainty for our pharmacies will ultimately help patients stay out of the Medicare donut hole and lower their out-of-pocket prescription drug costs.” – U.S. Rep. French Hill (R-Ark.), Second District

"Pharmacies play an essential role in the lives of Arkansans and people across the U.S. By incentivizing cost-savings for patients, this rule will support our dedicated community pharmacists as they work to improve health outcomes. We want families to have access to quality care and services, and fixing this systematic problem will help us do just that. This is a priority for the Administration and entire Arkansas delegation, and I hope to see the reform quickly finalized." – U.S. Rep. Steve Womack (R-Ark.), Third District


Pharmacy Benefit Managers (PBMs) manage price negotiations between pharmacies and insurance companies. While PBMs should ensure that Part D plan beneficiaries have the best available price for their medications and that pharmacists are fairly reimbursed, they have gotten into the business of retroactively levying ambiguous “DIR fees” on pharmacists, creating an environment of uncertainty. CMS’s proposed rule redefines “negotiated price” to include all pharmacy price concessions at the point of sale, essentially eliminating the retroactive fees.