Today’s twisted tale is that of a haunting… that is, the ghost who is haunting your third-party reconciliations…
… DIR fees.
Let’s jump right into the terror of these hidden fees.
Who created this monster?
DIR stands for “direct and indirect remuneration,” and it is a term coined by CMS to address price changes that could potentially change drug costs. These price changes may be overlooked at the point of sale.
DIR fees used to only be associated with Medicare prescriptions, but as time crept on and PBMs became creative, “DIR fee” became an umbrella term for the various fees that PBMs charge pharmacists for reconciliation or activity within a network.
There are three types of common DIR fees:
- “Pay to Play” – a fee to participate in a network
- “Payment Reconciliation” – the result of a target reimbursement rate
- “Performance Metric Fees” – pharmacy performance can result in a fee OR reimbursement reduction
How to end the nightmare
Are the DIR monsters under your pharmacy’s bed keeping you up at night?
Here are the proactive steps you can take to get rid of them once and for all:
Keep your wits about you
Don’t just let DIR fees rob you of your pharmacy’s profits. Be sure to reconcile your third-party payments and be aware of any hidden fees or reduced reimbursements in your reconciliations.
Your security blanket
Catch them before they catch you! Start monitoring your third-party profiles. Are all third-parties charging you exorbitant fees, or are a few specific ones causing all the damage? Once you pinpoint the troublesome third-parties, you can monitor their DIR fees within the PioneerRx pharmacy management system. (Contact your account manager for more information on monitoring different types of DIR fees for third parties.)
Don’t keep yourself in the dark
Currently, there are two bills (H.R. 5951 and S 3308) underway that could eliminate retroactive pharmacy fees. Contact your state’s representatives and senators and urge them to push these bills to become laws.
So, don’t sit idly by and let these ghosts terrorize your business! Take action today, and start busting DIR fees before they wreak havoc on your reconciliations!