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    Controversy heats up over pharmacy benefit manager DIR fees

     

    DIR fees reduce plan premiums

    Becky Rabbitt, vice president, government programs, Medicare, Express Scripts, rebuts that paying incentives for quality to pharmacies to drive adherence and decrease high-use medications can be done at point of sale. “It has to be continued over time,” she says.

    Two years ago, Express Scripts conducted a pilot program testing a risk and reward program for pharmacists, paying incentives for quality. If pharmacists drove adherence and decreased high-use medications, they received an incentive; if they didn’t perform as well as their peers, they received a penalty. “This couldn’t be done at point of sale,” Rabbitt says.

    She says that if pharmacists don’t drive quality, then DIR fees go back to insurers who can then reduce premiums. “If these monies are applied at POS, the reduced costs at POS must be covered by increased premiums. POS cost reductions benefit only those that take medications, while DIR fees help everyone in a health plan by providing lower premiums.”

    Rabbitt adds, “Pharmacists don’t like DIR fees and want them to be reconciled at POS, which doesn’t allow plans to drive STAR metrics. There would be no incentive for pharmacists to do anything but fill scripts.”

    She says pharmacies don’t read or understand their contracts related to DIR fees and that they have to change their way of doing business based on quality. “We see different levels of engagement from pharmacists; some are not paying attention to adherence,” she says. “They need to understand the fees’ impact on premiums.”

    Mari Edlin, a frequent contributor to Managed Healthcare Executive, is based in Sonoma, California.

     

    Mari Edlin
    Mari Edlin is a frequent contributor to Managed Healthcare Executive. She is based in Sonoma, California.

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