There have been a lot of changes in the pharmacy profession, and DIR fees have to be the worst idea to ever be conceived. DIR fees are “Direct and Indirect Remuneration Fees.” They are fees that Medicare and PBMs assess on pharmacies months after the prescription is filled. Pharmacies have no control over these fees and cannot even estimate what they will be. Pharmacies find out about these fees when they receive a notice months later that says “I know we said we would pay for this medicine, but we are now going to take part of the money back or possibly even more money than we paid you for the drug.” Medicare and PBMs claim that the fees are good for patients because it improves services. However, DIR fees have simply turned into a way for PBMs to remove all profit from pharmacies.

PBMs are huge and they are smart. They force pharmacies to send in invoices so they know exactly how much every pharmacy pays for drugs. They used this info to develop a system where they usually pay just over cost or even under cost. Many pharmacies just accept the losses and keep going. There is no real way to ever predict the amount they will take back. It is mathematically possible for the DIR fee to be higher than the total cost of the drug, so many pharmacies are actually paying to fill prescriptions instead of being paid to fill prescriptions. Pharmacy is one of the only professions that is not allowed to set their prices. 2022 is supposed to see the highest DIR fees yet. Imagine trying to do business knowing that your money will arbitrarily be taken away at some later date and there is no way to know how much it will be. That is the current state of the pharmacy profession.