What are DIR fees?

JD: So, DIR is [short for] “Direct and Indirect Remuneration.” It is a type of fee, at least for pharmacies, that’s charged on the back end by PBMs. And, in terms of remediating it, there’s a couple options. There’s obviously legislative efforts that have gone on for a couple years now, and haven’t really produced much. There is some efforts in a regulatory level with proposed rulemaking, but again those really haven’t gone terribly far. The big thing that we see in our practice is pharmacies actually stepping up and taking action. That could be engaging in a dialogue with the PBM or could be actually stepping up to the plate and filing some type of action, whether it be a litigation or arbitration. That is something that we’ve seen more and more clients do and with a greater degree of success.