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About serves as a resource to learn about DIR fees and their catastrophic impact to patient care. Resources include 3rd party videos, articles from leading media outlets, white papers, and positions from legislatures and industry experts. We encourage you to explore the resources, better understand the issue, and take action against DIR fees.

DIR fees were created by the Centers for Medicare and Medicaid Services (CMS).  The intent was to ensure that the federal agency had understood the scope of drug manufacturer rebates, so it would know the true cost of drug therapies and ensure compliance with Medicare regulations. The purpose was to allow Medicare to share in part of the savings realized from rebates.

Unfortunately, Pharmaceutical Benefits Managers (PBMs) – the companies that help implement Medicare Part D prescription drug plans – have adopted

the term “DIR” to justify charging onerous fees that actually increase costs for both the 55 million seniors who rely on Medicare and the taxpayers who fund this program.

Now, PBMs apply DIR fees retroactively to pharmacies based on their performance against “quality” metrics, most of which apply only to retail (not specialty) pharmacies. PBMs should acknowledge the inapplicability of these metrics to specialty pharmacies and create performance metrics that are applicable, and eliminate or recalibrate DIR fees.

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