# Plain Language Summary: Pharmacy DIR Reform To Reduce Senior Drug Costs Act

This bill addresses a problem with how pharmacy benefit managers (the companies that insurance plans use to manage prescription drug benefits) charge pharmacies and seniors for medications. Right now, these companies can charge pharmacies fees after the sale is complete—called "direct and indirect remittances" or DIRs—which can significantly reduce what pharmacies actually receive for filling prescriptions. The bill would restrict when and how these fees can be charged, making the pricing more transparent and predictable for pharmacies and seniors.

The practical impact is that seniors on Medicare could see lower out-of-pocket costs at the pharmacy counter. When pharmacies face unexpected fees after a sale, they often pass those costs along to customers or reduce their willingness to fill prescriptions. By limiting these surprise fees, the bill aims to make drug prices more stable and affordable for older Americans. Pharmacies would also benefit from knowing upfront what they'll actually be paid for medications, rather than discovering deductions later. The bill essentially tries to create a fairer system where the price you see when you pick up your prescription is closer to what the pharmacy actually receives.

This reform targets a specific but widespread practice in the pharmaceutical supply chain that many consumer advocates and pharmacists argue has driven up costs without providing clear benefits to patients. By making the system more straightforward, the bill could help seniors better predict their medication expenses and potentially access more affordable prescriptions.

Pharmacy DIR Reform To Reduce Senior Drug Costs Act

Tester, Jon

Pharmacy DIR Reform To Reduce Senior Drug Costs Act This bill establishes certain requirements for prescription drug plans and the prices of covered drugs under the Medicare prescription drug benefit. Specifically, the bill requires price concessions, payments, and fees that are negotiated with a pharmacy to be included in a drug's negotiated price, excluding incentive payments, and for this price to be provided at the point of sale. Additionally, prescription drug plans must report price concessions or incentive payments that are made after payment for covered drugs at the point of sale, including by contracted intermediaries, to the pharmacy at least annually. The Centers for Medicare &amp; Medicaid Services must establish standardized pharmacy performance measures with respect to incentive payments and price concessions; such measures must account for all pharmacy types, including specialty pharmacies, and focus on patient health outcomes and other targeted areas.