What Impact Does DIR Fees Have on Specialty Pharmacies?


Rinku Patel, PharmD, RPh, CEO and founder of KloudScript, discusses the impact of direct and indirect remuneration (DIR) fees.

Patel: There has been a lot of news, and DIR fees have [an] impact not only on specialty pharmacies but also in the pharmacy business in general but more importantly, its drastic impact of DIR fees could lead pharmacy—–especially if they don’t know what their DIRs are [or] what the contracts that they’ve signed with PBMs entail as far as potential DIR fees. It’s very very important that pharmacies have a thorough understanding of what their engagement with their PBMs are, either through direct contracts or their PSAO contracts, because ultimately not having that insight could land them in a negative margin situation after the drug has already been dispensed and already been given to the patient. Then they found out they actually lost money on that drug, because of the DIR fees or the chargebacks.

So, I think what’s important is for pharmacies to first and foremost be aware of what DIR fees [are] and the impact DIR fees could have on their potential PBMs and/or payer contracts that they’ve signed. And not only that, but to proactively review that on the time of dispense as best as they can based on the contractual requirements. Even though they’re not going to know the exact amount of DIR fees, with the high-level understanding of their contract they should know whether they’re going to be profitable dispensing that specialty medication or not. And it’s better to know that, even at a high level, ahead of time than to be in a situation where you’ve already begun caring for that patient and then now you’ve discontinued servicing that patient at the pharmacy because the pharmacy can’t afford the negative reimbursement that they would experience post DIR fees.

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