A new report from the National Community Pharmacists Association reveals some of the most pressing issues pharmacists faced in 2021 — and the findings are striking. The report, an economic health survey published late last month, gives witness to the financial viability of community pharmacies across the country. Over 5,000 pharmacy owners were asked to report on the economic health of their pharmacy, especially areas of concern. Over 300 owners responded. Their answers are as follows:

  • 41% of independent pharmacy owners report that the overall financial health of their pharmacy is “somewhat poor” or “very poor”
  • 68% of pharmacies have a hard time filling staff positions, particularly pharmacy technician positions
  • 60% of pharmacies have been impacted by supply chain disruptions
  • 64% of pharmacies are concerned about rising inflation
  • 76% of pharmacies believe that Congress will increase taxes on small businesses in the near future

In the wake of economic turmoil, independent pharmacies are struggling to survive. With so many concerns, though, one still reigns supreme.

As NCPA reports, “The top concern [of community pharmacists] is the impact pharmacy DIR fees will have on the viability of their small business. 97% of respondents state that they are significantly concerned with the impact DIR fees are having on their business.” 


To put this problem into perspective, 48.6% of pharmacists say that they will have to cut payroll if DIR fees are not reformed. 39.7% say that they will have to reduce services. 54.3% will have to reduce owner pay, and 25.6% will have to take other preventative measures to stay afloat. Most alarmingly, though, 25.6% of pharmacy owners say that, without DIR reform, they will have to close their pharmacy altogether.


DIR Fees: A Long and Infamous History

It’s no secret that PBMs have been cutting into pharmacists’ bottom line for years, under the guise of DIR fees. Over the past two decades, DIR fees have allowed PBMs to place “confusing, opaque, and often dubious performance standards” on pharmacies across the country — and the fees are only growing.

In fact, the Centers for Medicare & Medicaid Services (CMS) estimates that, between 2010 and 2019, pharmacy DIR fees increased by 91,500%. That’s right: 91,500%. That’s equivalent to a $4 gallon of milk surging up in price to $3,660. And DIR fees aren’t just expensive: they’re unexpected, coming weeks or even months after the point-of-sale.

As NCPA reports, “The topsy-turvy growth of the fees combined with the surprise factor makes it impossible for community pharmacies to control their expenses or manage cash flow, threatening all pharmacy operations, from dispensing lifesaving medications to administering COVID-19 vaccines and testing.”

And the reality is bleak. With a system like this set in place, the United States lost more than 2,300 pharmacies from 2017 to 2020 — and, as NCPA’s newest numbers suggest, more pharmacies will be on the chopping block if something isn’t done.

How can you make sure your pharmacy’s not next?

Ken and Ashley Duggins: Pioneers for Change

A dynamic husband-and-wife duo is on the frontline against DIR fees, and they can show you how to join the fight. In their native Asheboro, NC, Ken and Ashley Duggins own and operate Prevo Drug, not only protecting patients but also protecting pharmacists’ pocketbooks.

Over the summer, Ken and Ashley joined host Will Tuft on the Beyond the Scripts Podcast, where they discussed the ins and outs of DIR fees.

Prevo Drug has been in business since the start of DIR fees, and over the years, Ken — the business-minded one of the bunch — has had to keep up. He’s watched fees increase and accountability decrease on the part of PBMs; and he’s had to adjust his business model to stay afloat. While Ken believes the key to DIR fees is to treat the sickness, not the symptoms, he deals with unexpected costs on the day-to-day by staying prepared. His secret weapon? PioneerRx.

As Ken explains, “PioneerRx has everything we need [to predict DIR fees]. We get effective rates for prescription drugs at the beginning of every year, both name-brand and generic, then we program those rates into the PioneerRx system.”

With rates in place, Ken gets real-time notifications that notify him of the status of each of his claims, as well as the revenue expected from each claim. With features like Rx Edits and Rx Triggers, he can catch prescriptions with high DIR percentages and find an alternative Rx quickly and efficiently. With a powerful technology partner on their side, Ken and Ashley are mitigating fees and seeing higher profit margins — and they want you to do the same.

To learn more about PioneerRx’s DIR Fee capabilities, click here.

Keep Fighting the Good Fight

While Ken is passionate about scaling change on the day-to-day, Ashley advocates for making moves on a larger level. Ashley is actively involved in state and local associations that put pharmacies first. She says, “The biggest advice I can give any pharmacist [in fighting DIR fees] is to speak up. Stand up. You’ve got to be an advocate and you’ve got to fight for what’s right. Otherwise, your business is going to go by the wayside.”

Here are a few ways that you can get started:

  • Get in the know: Get connected with the right resources so that you can educate yourself on all the details of DIR fees
  • Stay up-to-date on the latest legal cases: Follow PioneerRx’s Pharmacy Laws and Regulations page to get the most accurate, up-to-date information on PBM reform and all other legal matters
  • Educate patients and other professionals: Find infographics, one-pagers, and educational materials that you can share with others here
  • Choose a technology partner that can power you forward: PioneerRx offers the most innovative solutions to manage and mitigate DIR fees. See our full range of capabilities and experience the benefits by scheduling a demo

As NCPA’s newest report shows, DIR fees have been — and continue to be — the biggest threat to community pharmacies. The longer they persist, the more dire the future of pharmacy becomes. Don’t throw in the towel yet, though. With enough passion, practice, and vigilance, community pharmacies can band together to make a difference in DIR fees.

As Ashley says, “We have to stick together. We have to fight for the same cause.” Then, and only then, will we see change.

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