Any professional in the pharmacy industry is likely aware of the current outrageous cost of DIR fees. In an attempt to address these exorbitant fees, in 2022 the CMS issued its final rule regarding Medicare Advantage and Part D participants for the Contract Year of 2024.
DIR reform is coming—but is your pharmacy prepared for the changes it will bring? In this blog, we take a look at what DIR reform looks like, as well as steps your pharmacy can take to handle these much-needed adjustments.
What Does DIR Reform Look Like?
As previously mentioned, the CMS recently issued its final rule: Medicare Advantage and Part D Final Rule for Contract Year 2024. This new rule will require Part D plans to include all pharmacy price concessions—otherwise known as DIR—in a pharmacy’s negotiated price at the point of sale. This means pharmacies will be able to see the “lowest possible reimbursement” for a Part D drug at the point of sale, which in turn will also lower a patient’s cost-share based on that lowest possible reimbursement.
For pharmacies like yours, these changes may result in the following:
- Drastically altered contracts with Part D Payors in 2024.
- PBMs proposing amendments and adjusting reimbursement altogether.
- Immediate, though temporary, cash flow issues in the first months of implementation.
These are just a few of the ways that DIR reform may impact your pharmacy and others like it. What steps should be taken in order to avoid any headaches or complications these changes may cause?
Preparing for DIR Reform
The adjustments coming to DIR in 2024 are well-known throughout the pharmacy industry. To better prepare for the potential changes in Part D contracts, PBM reimbursements, and cash-flow, your pharmacy should partner with a reputable pharmacy software vendor who is already working to address the impact of these shifts. This means your pharmacy software vendor should be doing things like:
- Expanding its partnerships with Part D Payors and other organizations that will work with your pharmacy to manage DIR reform-related changes.
- Recommending ways that your pharmacy can diversify its revenue, ensuring that any cash flow issues won’t drastically impact your business.
- Keeping you and other clients aware of any updates to the proposed DIR reforms.
Proactivity is key to your pharmacy’s success. If you don’t know if your current provider has started preparations for DIR reform, it may be time to consider a new pharmacy solutions vendor.
Outcomes® is the leading independent pharmacy solution vendor that works with pharmacists to enable them to diversify and improve their profitability through patient-centric care and clinical opportunities. Our diverse and robust features help our customers—independent pharmacists and their staff—navigate the challenges faced by modern pharmacies. All of our signature offerings, Rx30, Computer-Rx, OutcomesOne and PrescribeWellness, have all been designed to bridge the gaps in coverage that many other pharmacy solutions can’t cover. As the only complete solution with paid clinical revenue opportunities integrated directly in workflow, Outcomes proudly champions a patient-centric approach to pharmacy care.
Want to learn more about how Outcomes can help take your pharmacy into the future? Click here.
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