With shoppers already trusting their primary grocery store as an ally in health, pharmacies are another way for retailers to support consumers by enhancing the proposition of total store wellness. 

US Supreme Court

Rutledge v. Pharmaceutical Care Management Association

In February 2020, FMI filed an amicus brief in the U.S. Supreme Court case, Rutledge v. Pharmaceutical Care Management Association in support of the State of Arkansas.

The Case: The issue before the Court in Rutledge v. Pharmaceutical Care Management Association considers whether a preemption provision in the federal ERISA statute permits states to enact legislation that governs practices of PBMs.


Our Position: FMI supports the Arkansas statute that the Supreme Court is reviewing, 2015 Arkansas Act 900 (“Act 900”) and similar laws. This legislation protects public access to health care through pharmacies without altering the uniform administration of ERISA plans. Our brief focuses on two points: First, laws like Act 900 are needed to limit how PBMs abuse their concentrated market power, which threatens patient access to pharmacies. Second, this legislation, Act 900, does not interfere with the uniform administration of ERISA plans, which is incredibly important to a variety of FMI members with employees living or working in more than one state.

Timeline: Oral arguments before the Court are slated for April 27, 2020. Brief of FMI and 23 Retail Trade Associations as Amici Curiae in support of petitioner

Peter Matz
For questions or more information, please contact FMI's Director, Food & Health Policy, Peter Matz

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FMI's Pharmacy Report is a monthly communication to educate FMI members on the latest pharmacy-related actions that could impact food retailers and wholesalers. Read up on new federal and state pharmacy issues in the latest edition.

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Pharmacy DIR Fees: The Need for Reform

Direct and Indirect Remuneration fees, or DIR fees, were created with Medicare Part D, a prescription drug benefit program for elderly and disabled beneficiaries, to serve as a way for pharmacy benefit managers (PBMs) to report manufacturer rebates, so the federal government would be able to account for actual drug costs. Think of PBMs as the middlemen between health insurance companies and pharmacies. They serve as third-party administrators of prescription drug programs for commercial, self-insured, Medicare Part D and state/federal employee health plans.

DIR Fees Are Unfair, Arbitrary and Opaque


  • The original purpose of DIR fees has been hijacked. Now, PBMs use these fees to extract funds from pharmacies for every prescription filled, and this happens retroactively – weeks or months after the transactions.
  • Pharmacies dispense medications and are reimbursed, only to have a portion of that reimbursement “clawed back” by PBMs weeks or months after the transaction. There’s no way for pharmacies to anticipate the fees, and PBMs rarely (if ever) provide justification for the claw back.
  • A medication on which the pharmacy looks to break even or even turn a modest, fair profit at the time it’s dispensed can become a loss weeks after the retroactive fee is taken. This makes it extremely difficult for pharmacies to operate.
  • Pharmacy DIR fees also hurt patients. They increase out-of-pocket costs for needed medications and in doing so push seniors more quickly into the “donut hole” – the point at which they are responsible for 100% of their prescription drug costs until they reach the catastrophic coverage threshold when taxpayers begin paying 80% of the cost. Bottom line: If there were no DIR fees, then beneficiaries who take prescription drugs would have lower cost sharing.

Watch Our Video on Retroactive DIR Fees

According to the federal government, DIR fees have increased by 45,000% in less than ten years. Therefore, patients are facing higher out-of-pocket costs while pharmacies are struggling to stay in business.

Urge Congress to Pass the Phair Pricing Act

The bipartisan Phair Pricing Act of 2019 (H.R. 1034 / S. 640) would make all of the criteria for reimbursement determined at the point of sale, assuring that Medicare patients are properly charged and defending pharmacies from the financial uncertainties they currently face.

Tell Congress to Pass the Phair Pricing Act