Direct and indirect remuneration (DIR) fees are an issue that has caused outrage among a majority of pharmacy providers. These fees are charged by pharmacy benefit managers (PBMs) to pharmacies who operate within the network months after the initial transaction.

While some have strongly criticized these fees, PBMs have responded by saying that DIR fees are charged to ensure that pharmacies are providing the best care, and to reduce premiums for Medicare beneficiaries.

The Pharmaceutical Care Management Association (PCMA), a support organization that advocates for PBMs, has spoken out against those attacking PBMs for charging DIR fees.

“They don’t harm the health industry in any way. They only help it,” PCMA President and CEO Mark Merritt told Specialty Pharmacy Times in an interview. “It reduces costs for consumers and for Medicare. The reason people attack DIR is they sign a contract to pay for it, and then they don’t want to hold up their end of the bargain. The reality is payers are going to demand discounts, concession, and rebates to reduce costs to pass those savings along to consumers.”

PCMA argues that recently published reports about DIR fees are inaccurate, and spreading misinformation. However, the Community Oncology Alliance (COA), who commissioned a report highlighting how DIR fees can harm patients, counters that there is limited evidence to support the stance of PBMs.
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