How DIR Fees Affect Specialty Pharmacists


Jesse C. Dresser, Esq explains how DIR fees affect specialty pharmacists at the NASP Annual Meeting in Washington, DC.

JD: So, DIR fees as it applies to the specialty pharmacy patients is kind of twofold. As to specialty pharmacies, one of the biggest challenges is that it’s applied on the backend. And so what might have been a profitable or at least a claim that was being reimbursed at cost at the front end now becomes underwater, where they’re actually losing money to fill that prescription. The other problem too is 90% of the time, the metrics that are being used by the PBMS to figure out what the DIR should be have no bearing whatsoever on specialty pharmacies. It might be something related to diabetes adherence, or something related to statins, or something like that. It has nothing to do with products and services actually done by specialty pharmacists. As for patients, it’s really terrible because what it does is that it inflates their out-of-pocket. If there’s a 5% fee that’s charged on the back-end, but not on the front-end, it means that they’re paying a co-pay or a coinsurance based on a higher amount when it’s actually lowered on the back end. From a patient’s perspective, especially on a high-cost specialty drug, that could be a couple hundred dollars a month.

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