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Outside-the-Box Ideas for Offsetting Extra DIR Fees During the 2024 DIR Hangover

DIR fees are changing in 2024. Starting in the first quarter, the direct and indirect remuneration (DIR) fees that have traditionally been imposed 3 to 6 months after a prescription is filled will be moving to the point of sale. And while this move does offer more transparency than previous collection methods, it does present a problem of its own: What are pharmacists supposed to do during the period in the first part of 2024 when DIR fees are being taken from the point of sale while 2023’s retroactive DIR fees are coming due?

How Pharmacies Are Responding to the DIR Hangover

The “DIR Hangover” is a term coined by industry publications and pharmacy groups to describe the financial challenges that pharmacists and pharmacy owners will face in early 2024. But how are pharmacies responding to it?

Some pharmacies are cutting costs by streamlining their operations, automating as many tasks as possible and making the most of every minute they have. Others are attempting to negotiate better contracts with the pharmacy benefit managers (PBMs) that are collecting the DIR fees. And other pharmacies are taking the opportunity to diversify and expand their service offerings, providing clinical services — like vaccinations and point-of-care testing — which aren’t subject to DIR fees.

But, for many pharmacies, these strategies may not be enough to offset the full impact of the DIR Hangover. And if the more traditional methods turn out to not be enough, it may be time to consider some outside-the-box ideas.

(For a more comprehensive look at the DIR hangover and how you can build an action plan for your pharmacy, check out our popular e-book, “The 2024 DIR Fee Hangover Playbook: How to Keep Your Pharmacy in the Game.”)

Download the DIR Hangover Playbook!

Responding to the DIR Hangover by Thinking Outside the Box

Expanding into clinical services and diversifying revenue streams are proven methods for boosting pharmacy revenue. But what else can a pharmacy do to offset DIR fees? Here are a few suggestions:

Rethink Your Marketing Efforts to Draw More Business

Outreach is everything. One of the most obvious ways to offset the DIR Hangover would be to draw more business to your store, specifically if that business is not impacted by DIR fees. To do that, it’s time for pharmacies to rethink their marketing efforts to reach new customers and promote their non-pharmacy products and services.

Pharmacies have a variety of marketing channels at their disposal, including social media, email marketing, and direct mail, to highlight the clinical services they offer. Other ideas include targeting a community’s new residents; creating a rewarding customer referral program; and establishing a new customer program that uses staff meet-and-greets, a quick tour of the pharmacy and its services, and even a gift certificate to encourage a return visit after the first time a new patient fills a prescription.

Offer Pet Medications for Your Furry & Feathered Patients

“People love their pets and want to take care of them,” says Jason Ausili, PharmD, MSLS, Head of Pharmacy Transformation for EnlivenHealth. “Pharmacists can ideally produce the unique dosage forms that are more palatable and efficacious for pets.”

Offering pet medications provides a variety of benefits for both your pharmacy and for pet owners in your community. Your pharmacy will be tapping into an entirely new patient pool — one that largely pays cash for their medications and doesn’t involve any kind of insurance. Meanwhile, pet owners will benefit from your expertise, as well as the fact that you will likely be able to offer them their pet’s medications for less than their vet would charge.

For even more on this topic, watch our on-demand webinar, “The DIR Hangover Remedy: Proven Strategies for Overcoming 2024’s Greatest Challenge,” featuring a panel of clinical, financial, and analytics experts!

Mitigate Your DIR Hangover Risk with Medicare Plan Comparisons

Medicare Part D plans vary widely in their DIR fees. By helping Medicare beneficiaries compare plans, pharmacies can help them save money and reduce their own DIR risk. When looking for plans that save on your patients’ out-of-pocket costs, check to see how those plans assess DIR fees. Some plans use adherence as a factor in setting your fees, making them a good fit for patients who consistently pick up their refills on time. Other plans either don’t use adherence as a metric, or they measure it at the PSAO level, making those plans a better fit for your less adherent patients. And, though they are rare, some plans out there don’t impose DIR fees at all.

To best offer this service, pharmacists should use a Medicare plan comparison tool like EnlivenHealth’s Medicare Match. With the right training, both pharmacists and pharmacy technicians can easily perform plan comparisons for Medicare patients.

Boost Your Front-End Profits with a Store Refresh

Don’t underestimate the front end of your store. To maximize front-end profits, pharmacies should focus on improving the overall customer experience, from the store’s appearance to the products and services offered. This can be achieved by identifying and addressing any areas that are not up to par, utilizing available resources to enhance the store’s aesthetic, and strategically promoting products and services that align with customer needs and preferences.

Even something as small as making sure your shelves don’t look overcrowded can contribute to customer comfort and increase the likelihood that your patients will take a little more time browsing up front when they come to pick up their prescriptions.

It’s Time to Diversify

The DIR Hangover is going to be a challenging time for pharmacies, but there are a number of things you can do to offset the last of these retroactive DIR fees. By diversifying your income, overhauling the front end of your store, and rethinking your marketing efforts, you can protect your bottom line and keep your pharmacy thriving.

For a comprehensive overview of the 2024 DIR Hangover and actionable strategies to prepare for it, check out EnlivenHealth’s e-book, “The 2024 DIR Fee Hangover Playbook: How to Keep Your Pharmacy in the Game,” available for free for a limited time!


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FDSRX is now part of EnlivenHealth®