Are you ready for DIR changes coming in 2024?
Beginning January 1, 2024 Medicare Part D direct and indirect remuneration (DIR) fees will be applied at the point-of-sale. This means that the real-time reimbursement a pharmacy receives will be the final reimbursement rate on the Medicare Part D claims.
The good news …
This change is GOOD NEWS for pharmacies in that you will no longer have to deal with retro-active DIR fees and trying to determine what your actual claim reimbursement is months after Medicare Part D claims are adjudicated. You will immediately know your reimbursement at the point-of-sale.
The bad news …
The BAD NEWS for pharmacies is that the point-of-sale reimbursement you receive on most Medicare Part D claims will now be lower. In addition, during the first several months of 2024 pharmacies will still be charged retroactive DIR fees from some PBMs for 2023 claims. As a result, you will likely experience a cash flow issue in early 2024.
Pharmacies MUST START PLANNING NOW!
It’s important that you evaluate your current retroactive DIR fees and estimate the dollar volume of these fees you will be charged in the first 6 months of 2024. Set aside funds and/or investigate other forms of revenue generation now so that you will have financial resources available during the early months of this change. This change is good news for pharmacies because it will lead to better transparency on your reimbursement for Medicare Part D claims. Do some planning NOW so that you don’t have added cash flow stress as we bring in 2024.