It’s a new year, but direct and indirect remuneration (DIR) fees combined with decreased reimbursement continue to cause local pharmacies to shut their doors. As you’re likely all too aware, Pharmacy Benefit Managers (PBMs) have made charging pharmacies DIR fees, a common practice. These fees levied on your business can not only be overbearing and obtrusive but also frustrating and confusing.
And while DIR fees are inevitable, they can be minimized – at least in part. More on that in a minute.
What exactly are DIR fees?
The Centers for Medicare & Medicaid Services (CMS) originally intended for DIR fees to serve either as a reconciliation between the claim and the negotiated drug price or as a “pay to play” to PBMs for participating in a preferred network. However, in recent years, a trending DIR fee iteration unceremoniously became prevalent where the PBM can claw money back from the pharmacy for failing to hit certain, arbitrarily imposed performance-based standards. Viewed as a “catch-all”, it is this version of the DIR fee that has drawn widespread contempt from pharmacies for often creating a scenario where the business receives insufficient reimbursement to cover costs – hardly a sustainable model.
The current status
Despite some encouraging momentum last year surrounding a push for bi-partisan federal legislation aimed at lowering drug-pricing and DIR fee reform, Congress does not seem imminently poised to act. Absent legally sanctioned and much-needed financial relief, the status of DIR fees remains unchanged, forcing businesses to continue to feel their negative financial effects.
Reduce DIR fees with PrescribeWellness
The best way to beat DIR fees is by proactively recognizing and understanding which plans are grading your performance on the pharmacy level or an aggregate PSAO level, and prioritizing your efforts to maximize performance.
We previously discussed how to best plan for and beat DIR fees, and now we’re back with two more important and effective mitigation strategies that will simultaneously allow your practice to continue providing optimized patient care while also caring for your business’ bottom line.
The PrescribeWellness solution expands patient care, streamlines workflow, and improves customer loyalty, all of which lead to enhanced patient outcomes and pharmacy performance.
Improve performance metrics
Medication adherence plays a critical role in reducing DIR fees – especially among those patients who suffer from chronic conditions, such as diabetes, high blood pressure, and high cholesterol. And there’s no more effective method for improving adherence than by growing and sustaining patients in a Med Sync program.
The PrescribeWellness Med Sync solution allows you to align patient prescriptions to a single monthly appointment date and enables pharmacies to engage their patients in a convenient and consistent manner. By taking a proactive approach to patient care, Med Sync reduces days without medication coverage, which leads to improved adherence and pharmacy performance metrics. In fact, according to an NCPA study, patients on med sync are almost 2.5 times more likely to be adherent to their medication, helping pharmacy businesses to reduce DIR fees while improving patient outcomes – a big win-win.
Become a healthcare destination
Another effective way to mitigate the negative impact of DIR fees is by simply generating more revenue – specifically from opportunities that don’t involve PBMs, such as clinical services. By adding or expanding your practice’s clinical service offerings, your business will generate additional revenue streams free from the burden of DIR fees.
From Medicare plan reviews to COVID-19 testing – and everything in between – the PrescribeWellness solution helps identify and recruit patients for an array of clinical services. In fact, through eCare plans, PrescribeWellness can also help you document, share, and bill for encounters. Patients are increasingly turning to pharmacists to receive non-emergent care – now is the time to determine which clinical services you will offer, implement them, and watch your pharmacy’s profitably grow!
Want to learn more about how PrescribeWellness can help you take control of your business through actionable solutions? Contact us today – we love hearing from you!
https://www.pharmacytimes.com/news/white-paper-dir-fees-simply-explained
https://www.pbahealth.com/offset-pharmacy-dir-fees-and-pbm-reimbursements-with-these-alternative-revenue-ideas/
