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The Effects of DIR Fees

DIR fees are to community pharmacy what a millstone is to the neck of a distance swimmer. They drag us down, they keep us from doing what we are trained to do, and eventually they will suffocate us. So why are we accepting them? Is anybody doing anything to stop, roll back, slow, delay, or prevent these onerous fees from destroying practices?

Maybe we first need to ask, “Who really cares?”. If DIR fees are impacting your profitability, does anyone other than you really care? Nope! No one will care until it impacts them. They will only care when they can no longer get a prescription filled because your pharmacy is not there to provide the services they need. The current cry against DIR fees is almost universally community pharmacy driven. The chains don’t care. Chains can sell another package of Fruit of the Loom’s or another TV and make up the difference. Patient based, community pharmacies do not have that luxury. We depend upon the care we give to fund the care we can give. Therein lies the rub. We (community pharmacies) are being charged a premium in order to be able to provide inferior service to patients. When, all the while, we should be paid more to provide superior patient care.

Take a look at “performance DIR fees”. Supposedly a DIR fee based on performance will allow a “high quality pharmacy” to receive a greater reduction in fees as compared to a “low quality pharmacy”. (Understand that quality here is defined by a third party based on numbers not designed to “rate” pharmacy performance.) In fact, if you have a pharmacy that is perceived as high quality based on things like PDC adherence rates and MTM completion rates you should expect to receive lower fees and more patients because of that performance. If you receive more patients it is quite probable they will be less adherent and less likely to respond to MTM requests. In which case, your “quality numbers” tank, your DIR fees rise, and you have more patients that cause you to lose more money on each prescription filled. That is bad for the patient, bad for your pharmacy, bad for CMS, and bad for the healthcare system.

So, who’s doing something about this? We are. And we’ve got help. MedHere Today is assisting NCPA in their efforts to address this legislatively, we’re talking to CMS about access and quality issues, we’re speaking out in national forums to raise awareness, and talking to congressional and senatorial officers to help them understand the issues.

You think DIR fees are not fair? A fair is a place you go to eat greasy food and watch creepy clowns make balloon animals. Fair has no place in this discussion. This discussion must be joined around patient access (my pharmacies are dropping plans with particularly onerous DIR fees limiting those patients access to care) and quality of care. This discussion must center on the patient, not the impact the DIR fees have on your business. Once we convince congress of the deleterious effects of these impossibly high fees, and the limited positive impact on patients, we can then speak to their effects on our small businesses and what Main Street will look like without us.

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