What Steps Need to be Taken to Combat DIR Fees?

Lanton: [Direct and indirect remuneration] fees are having a really big impact on specialty and the health care system in general. We’ve been telling people about DIR fees since around 2013. We saw it creep up in a lot of retail facilities and we knew it was going to go to specialty, it was just a matter of when.

Now, it seems to have accelerated. Now, all of these specialty pharmacies are saying ‘oh my gosh this is a big problem,’ and it is.

What we’re doing is telling people we’ve actually a bill we had in Maine—it was LD 6—and we had it as a DIR bill and also as a clawback bill. What we’ve learned is that some legislatures are a little apprehensive with looking at DIR because they’re thinking it’s a jurisdictional issue, they’re thinking it’s a federal issue. What we are trying to tell people is it’s not a federal issue, it’s also a dual-eligible issue.

So [legislators] are like ‘where’s the data?’ We’re thinking ‘wow that’s another one,’ because outside of Medicare Part D, a lot of people haven’t been able to track the data. That’s one thing that I tell people—if you’re doing DIR legislation, make sure you have your data.

We know a lot has not crossed into commercial yet. We know it will. So, if we can start looking at some of those claims, if that’s possible, that’s one thing I would do.

I think at least getting those steps in place to have that conversation will be a better step in solving the DIR problem.