What the Medicare Changes Mean for Your Pharmacy

Although DIR fees are nothing new for pharmacies, they have increased at a rapid rate over the last ten years. In fact, DIR fees have risen so much that they significantly impact the profitability for many pharmacies. Not only are pharmacies hit with surprise fees months after claims have been processed, but in some cases, the pharmacy ends up providing the medication below cost. To address this and work towards better medication price transparency, legislative reform efforts are in the works. This includes the May 2022 Centers for Medicare & Medicaid Services (CMS) final rule. Beginning January 2024, the new rule will revise several areas of the Medicare Advantage (Part C) and Medicare Prescription Drug Benefit (Part D) programs, including Star Ratings and DIR fees. The changes will affect patients, payors and pharmacies, so it’s important to be aware of what’s coming. Read more >