Direct and Indirect Remuneration Fees: The Controversy Continues

Abstract

The Centers for Medicare and Medicaid Services (CMS) initially created direct and indirect remuneration (DIR) fees with the enactment of Medicare Part D in order to track rebates and other price adjustments made to pharmacy benefit managers (PBMs). PBMs have expanded the use of these fees to “claw back” money from pharmacies on already dispensed medications. Community and specialty pharmacies claim these fees are not transparent, hurt patients and taxpayers, and negatively impact their fiscal bottom line, while PBMs assert that these fees actually reduce premiums for patients. Congress has stepped into the dispute by introducing legislation that would halt retroactive DIR fees.