A white paper commissioned by the Community Oncology Alliance (COA) examines the practice of “direct and indirect remuneration” (DIR) fees administered by PBMs and how they could drive up drug prices for Medicare Part D beneficiaries and taxpayers. The paper contends that “over the last year or so, DIR fees have been twisted by PBMs into an abusive and overly-broad ‘backdoor’ vehicle for clawing back additional monies and increasing their own profits.” According to the report, PBMs now charge “performance-based” DIR fees to pharmacies based on inappropriate quality metrics. These “murky and opaque” retroactive charges create a lack of transparency as the pharmacies cannot account for the net price of a drug claim until after the PBM takes back the DIR fee, the report asserts.

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