Seniors deserve choices when deciding where to go for lifesaving prescription drugs. Thankfully, pharmacy options have expanded over the last decade to include specialty pharmacies. But now, patient choices are shrinking, threatened specifically by direct and indirect remuneration (DIR) fees imposed by large Pharmacy Benefit Management firms (PBMs). PBMs implementing Medicare Part D programs have created many types of onerous fees that imperil the number of choices presented to one of America’s most vulnerable populations: seniors.