Top Issue:
DIR Fees

DIR fees are a mechanism regulated by CMS which allows Part D plans to charge a per prescription fee to pharmacies.  Plans are increasingly expanding the use of these fees as alternative means of extracting price concessions outside the time of adjudication.  These fees can take many forms, such as a fee tied to specific performance metrics (e.g. generic dispensing rates); fees to be part of a preferred cost share pharmacy network; or to reconcile point-of-sale reimbursement with contracted rates.  Some DIR fees are not negotiable.  Additionally, DIR fees are deducted post adjudication from each paid claim; they do not show on the adjudicated response.  When Part D plans do this, the price of the prescription can appear higher than the actuarial benefit, leaving patients with higher copays and cost sharing.

Our Position

AmerisourceBergen (ABC) is committed to fair, accurate, and timely reimbursement for its pharmacy partners.  Delays or uncertainty in payments destabilizes the viability of pharmacies and patient access to life-saving medications. So called “Direct and Indirect Remuneration” (DIR) fees that are imposed by PBMs retroactively make it difficult for pharmacies to determine the actual reimbursement at the time of dispensing.  That is why ABC supports greater transparency on DIR fees and having them assessed at point of sale rather than retroactively.