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6 Things Every Pharmacy Should Know About DIR Fees During Medicare Open Enrollment

DIR fees have long been a struggle for pharmacies. It’s difficult to know exactly how much you’ll be charged and because these fees are applied retroactively, financial planning can become a nightmare. At the same time, your patients’ well-being and wallets can be negatively impacted by them as well. 

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However, this Medicare Open Enrollment period is the perfect opportunity to take control over your DIR fees using a few key techniques to improve your pharmacy’s bottom line and better care for your patients.

Let’s get started with six things every pharmacy should know about DIR fees during Medicare Open Enrollment this fall.

1. Medicare Open Enrollment is your best opportunity to reduce DIR fees for the coming year

For many patients, Medicare Open Enrollment is the only time of year to make changes to their Medicare plans, whether they’re newly eligible or shopping for a new one. That makes this a critical time for pharmacists like you to offer your help and guidance.

This also makes Medicare Open Enrollment the perfect time to take the lead on DIR fees. By comparing plans and identifying cost opportunities, you may be able to achieve significant savings for your patients – and your pharmacy.

However, it’s often challenging to know how a plan will impact each patient’s medication expenses and your pharmacy’s DIR fees. Luckily, FDS Amplicare lets you easily and automatically review patient-specific information to estimate cost differences between plans, including the potential impact of DIR fees.

Medicare Open Enrollment is your opportunity to shine and many of the pharmacists we speak to use it to generate buzz around comparing plans to help patients better understand their options. With social distancing during the COVID-19 pandemic a major concern for the Medicare population, you can even reach out digitally using the FDS Amplicare platform to make sure your patients have the support they need this fall.

2. To lower DIR fees, opt for plans based on store-level performance, instead of the aggregate PSAO level

It’s tricky to control DIR fees, although sometimes they’re based on performance metrics that your pharmacy can affect. For example, medication adherence (assuring that your patients refill and pick up their prescriptions) is a huge part of achieving high performance.

The problem is that not all plans are based on store-level performance. Instead, they use the PSAO aggregate, which is the performance of pharmacies in your network. In this case, your DIR fees are defined by how others perform. 

Obviously, that’s not ideal, so FDS Amplicare’s platform will help you to easily identify plans based on your store’s individual performance.

3. In your plan contracts, look for these terms to identify hidden DIR fees

DIR fees are often hidden in contracts, making them challenging to identify. It’s nearly impossible to save on fees if you don’t know how they’re labeled and what you’re looking for. Some common phrases include “rate guarantees,” “performance adjustments,” or “post point-of-sale adjustments.”

These are just some terms that actually mean DIR fees. For your reference, you can see a full list of terms in our DIR Fees Guide to get you up to speed.

4. DIR fees often focus on medication adherence, so help patients migrate to plans that fit their situation accordingly

This strategy, called DIR Mitigation by Migration, involves using patient adherence to identify opportunities for patients to move to more cost-effective plans.

Simply put, if a patient is highly adherent, you can use FDS Amplicare to identify plans that are the most cost-effective for them and base DIR fees on high adherence. If they’re not very adherent, you can find cost-effective plans where DIR fees don’t punish low adherence. (In addition, you should work to improve their adherence in the coming year!) During Medicare Open Enrollment, you can guide patients to cost savings by helping them compare their plan options. 

5. Improve your Star Rating for bonuses, but remember it won’t necessarily help with DIR fees

Performance metrics and Star Ratings are two separate systems. While it’s great to get a five-star rating (and you can receive bonuses from it), your DIR fees are exclusively based on performance metrics, so you should focus on these areas to move the needle. For a deeper dive, you can get a complete run-down of actionable opportunities in our DIR Fees Guide.

6. FDS Amplicare is your go-to tool for Medicare Open Enrollment success

FDS Amplicare can help you reduce DIR fees during Medicare Open Enrollment because our software makes it easy to identify opportunities to help your patients and reduce your pharmacy’s costs. Here are just a few key ways:

  • Use plan comparisons with patient-specific info: FDS Amplicare analyzes patient data, pharmacy data, and plan information to deliver comparisons for Part D, Medicare Advantage, and Medigap plans in seconds.
  • Enhanced patient insights and reporting: The FDS Amplicare “Win-Win Report” makes it easy to identify high-value, conflict-free win-win opportunities that save your patients out-of-pocket costs and also improve the bottom line for your pharmacy.
  • Communicate options to patients using digital marketing methods: FDS Amplicare lets you send messages to your patients about their options. This makes it easy for them to view opportunities and consult with you before switching, especially during social distancing due to the COVID-19 pandemic.
  • Identify opportunities for patient interventions, including performance metrics: Changing plans isn’t the only way to save on DIR fees. FDS Amplicare helps you find other ways to boost your performance metrics and reduce costs, including simple actions like sending refill reminders and the insight to preemptively address the potential side effects of prescriptions.

Instead of leaving DIR fees to chance this fall, you can use Amplicare to gain the visibility to help find the best plans for your patients – and your pharmacy.

We’ll show you how to set your pharmacy up for Medicare Open Enrollment success so you can focus on patient care, not DIR fees.



Amplicare is now part of EnlivenHealth®


FDSRX is now part of EnlivenHealth®