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A New Way to Tackle DIR Fees


Arnela Jusupovic - October 27, 2020 - 0 comments

A New Way to Tackle DIR Fees

J&R Pharmacy in Benton, KY got a big DIR fee reimbursement check with their name on it this year. Want to learn how they did it?

It’s all thanks to a strategy called Mitigation Through Migration. Certain insurance plans offer rebate incentives for having adherent patients, and if you can move your most adherent patients to these plans – that means more money in your pocket and less in the PBMs’. It also works the other way around. Your patients that are not adherent should be moved off of these plans onto one that doesn’t have adherence as a metric, or is weighted at the PSAO level. This “migration” of patients to the most effective plans for their current adherence state saves your pharmacy money and also saves the patients money on out-of-pocket costs. It’s a win-win situation.

How J&R Pharmacy Did It

Blake Wiseman works at J&R Pharmacy, where he describes his role as “the go-to for everything there is.” The pharmacy has been owned by his family for 65 years and is still going strong. “My granddad is 91 years old, and he still works every day,” Wiseman says. They have been focusing on becoming more clinical and finding ways to diversify their revenue. 

This DIR fee mitigation technique is something that they started one year after realizing they had spent just over $200,000 in DIR fees. “When that happened, we started really trying to figure out…how we could mitigate these people that are costing so much money and also increase our adherence,” Wiseman explains. By using Amplicare Match, they were able to find the plans that they wanted to target during Open Enrollment. You can target the plans that will send you reimbursement checks to reward you for having adherent patients. Amplicare helps identify the DIR impact of Medicare Part D plans and positions you to choose the plans that best benefit your pharmacy and your patients. “I wouldn’t do it just for our bottom line,” emphasizes Wiseman. “I would make sure that it would help the patient’s pocket as well. But 99 percent of the time, we can find a plan that actually saves them money and saves us money on DIR fees.” 

The PioneerRx system integrates with Amplicare to build notifications and alerts into your workflow. “That’s probably been the single best thing that has helped us with our adherence rate, because during workflow we can flag people that are not adherent,” Wiseman says. By exploring the capabilities of their technology and taking advantage of these opportunities, J&R Pharmacy is able to get paid for their patients’ adherence. It’s an effective new way of tackling DIR fees.

Your Pharmacy Can Do It Too

To learn more about DIR Mitigation through Migration, sign up for this webinar on Thursday, October 29th at 3 PM CDT. You’ll hear about proven strategies and tactics for the upcoming Open Enrollment season. You can also read Amplicare’s Ultimate Guide to Open Enrollment for a complete overview of 5 major issues that pharmacies will face this fall and how to solve them. 

Some final words of advice from Blake Wiseman: “Take advantage of these [technology] companies out there,” he urges. “Use them to help mitigate your cost when it comes to these PBMs and every penny they try to take back from you.”