Accessibility Statement Skip Navigation
  • Why PRWeb
  • How It Works
  • Who Uses It
  • Pricing
  • Login
  • GDPR
  • Create a Free Account
Return to PRWeb homepage
  • News
  • Resources
  • Contact
When typing in this field, a list of search results will appear and be automatically updated as you type.

Searching for your content...

No results found. Please change your search terms and try again.
  • News in Focus
      • Browse News Releases

      • All News Releases
      • Multimedia Gallery

      • All Multimedia
      • All Photos
      • All Videos
  • Business & Money
      • Auto & Transportation

      • Aerospace, Defense
      • Air Freight
      • Airlines & Aviation
      • Automotive
      • Maritime & Shipbuilding
      • Railroads and Intermodal Transportation
      • Supply Chain/Logistics
      • Transportation, Trucking & Railroad
      • Travel
      • Trucking and Road Transportation
      • View All Auto & Transportation

      • Business Technology

      • Blockchain
      • Broadcast Tech
      • Computer & Electronics
      • Computer Hardware
      • Computer Software
      • Data Analytics
      • Electronic Commerce
      • Electronic Components
      • Electronic Design Automation
      • Financial Technology
      • High Tech Security
      • Internet Technology
      • Nanotechnology
      • Networks
      • Peripherals
      • Semiconductors
      • View All Business Technology

      • Entertain­ment & Media

      • Advertising
      • Art
      • Books
      • Entertainment
      • Film and Motion Picture
      • Magazines
      • Music
      • Publishing & Information Services
      • Radio & Podcast
      • Television
      • View All Entertain­ment & Media

      • Financial Services & Investing

      • Accounting News & Issues
      • Acquisitions, Mergers and Takeovers
      • Banking & Financial Services
      • Bankruptcy
      • Bond & Stock Ratings
      • Conference Call Announcements
      • Contracts
      • Cryptocurrency
      • Dividends
      • Earnings
      • Earnings Forecasts & Projections
      • Financing Agreements
      • Insurance
      • Investments Opinions
      • Joint Ventures
      • Mutual Funds
      • Private Placement
      • Real Estate
      • Restructuring & Recapitalization
      • Sales Reports
      • Shareholder Activism
      • Shareholder Meetings
      • Stock Offering
      • Stock Split
      • Venture Capital
      • View All Financial Services & Investing

      • General Business

      • Awards
      • Commercial Real Estate
      • Corporate Expansion
      • Earnings
      • Environmental, Social and Governance (ESG)
      • Human Resource & Workforce Management
      • Licensing
      • New Products & Services
      • Obituaries
      • Outsourcing Businesses
      • Overseas Real Estate (non-US)
      • Personnel Announcements
      • Real Estate Transactions
      • Residential Real Estate
      • Small Business Services
      • Socially Responsible Investing
      • Surveys, Polls and Research
      • Trade Show News
      • View All General Business

  • Science & Tech
      • Consumer Technology

      • Artificial Intelligence
      • Blockchain
      • Cloud Computing/Internet of Things
      • Computer Electronics
      • Computer Hardware
      • Computer Software
      • Consumer Electronics
      • Cryptocurrency
      • Data Analytics
      • Electronic Commerce
      • Electronic Gaming
      • Financial Technology
      • Mobile Entertainment
      • Multimedia & Internet
      • Peripherals
      • Social Media
      • STEM (Science, Tech, Engineering, Math)
      • Supply Chain/Logistics
      • Wireless Communications
      • View All Consumer Technology

      • Energy & Natural Resources

      • Alternative Energies
      • Chemical
      • Electrical Utilities
      • Gas
      • General Manufacturing
      • Mining
      • Mining & Metals
      • Oil & Energy
      • Oil and Gas Discoveries
      • Utilities
      • Water Utilities
      • View All Energy & Natural Resources

      • Environ­ment

      • Conservation & Recycling
      • Environmental Issues
      • Environmental Policy
      • Environmental Products & Services
      • Green Technology
      • Natural Disasters
      • View All Environ­ment

      • Heavy Industry & Manufacturing

      • Aerospace & Defense
      • Agriculture
      • Chemical
      • Construction & Building
      • General Manufacturing
      • HVAC (Heating, Ventilation and Air-Conditioning)
      • Machinery
      • Machine Tools, Metalworking and Metallurgy
      • Mining
      • Mining & Metals
      • Paper, Forest Products & Containers
      • Precious Metals
      • Textiles
      • Tobacco
      • View All Heavy Industry & Manufacturing

      • Telecomm­unications

      • Carriers and Services
      • Mobile Entertainment
      • Networks
      • Peripherals
      • Telecommunications Equipment
      • Telecommunications Industry
      • VoIP (Voice over Internet Protocol)
      • Wireless Communications
      • View All Telecomm­unications

  • Lifestyle & Health
      • Consumer Products & Retail

      • Animals & Pets
      • Beers, Wines and Spirits
      • Beverages
      • Bridal Services
      • Cannabis
      • Cosmetics and Personal Care
      • Fashion
      • Food & Beverages
      • Furniture and Furnishings
      • Home Improvement
      • Household, Consumer & Cosmetics
      • Household Products
      • Jewelry
      • Non-Alcoholic Beverages
      • Office Products
      • Organic Food
      • Product Recalls
      • Restaurants
      • Retail
      • Supermarkets
      • Toys
      • View All Consumer Products & Retail

      • Entertain­ment & Media

      • Advertising
      • Art
      • Books
      • Entertainment
      • Film and Motion Picture
      • Magazines
      • Music
      • Publishing & Information Services
      • Radio & Podcast
      • Television
      • View All Entertain­ment & Media

      • Health

      • Biometrics
      • Biotechnology
      • Clinical Trials & Medical Discoveries
      • Dentistry
      • FDA Approval
      • Fitness/Wellness
      • Health Care & Hospitals
      • Health Insurance
      • Infection Control
      • International Medical Approval
      • Medical Equipment
      • Medical Pharmaceuticals
      • Mental Health
      • Pharmaceuticals
      • Supplementary Medicine
      • View All Health

      • Sports

      • General Sports
      • Outdoors, Camping & Hiking
      • Sporting Events
      • Sports Equipment & Accessories
      • View All Sports

      • Travel

      • Amusement Parks and Tourist Attractions
      • Gambling & Casinos
      • Hotels and Resorts
      • Leisure & Tourism
      • Outdoors, Camping & Hiking
      • Passenger Aviation
      • Travel Industry
      • View All Travel

  • Policy & Public Interest
      • Policy & Public Interest

      • Advocacy Group Opinion
      • Animal Welfare
      • Congressional & Presidential Campaigns
      • Corporate Social Responsibility
      • Domestic Policy
      • Economic News, Trends, Analysis
      • Education
      • Environmental
      • European Government
      • FDA Approval
      • Federal and State Legislation
      • Federal Executive Branch & Agency
      • Foreign Policy & International Affairs
      • Homeland Security
      • Labor & Union
      • Legal Issues
      • Natural Disasters
      • Not For Profit
      • Patent Law
      • Public Safety
      • Trade Policy
      • U.S. State Policy
      • View All Policy & Public Interest

  • People & Culture
      • People & Culture

      • Aboriginal, First Nations & Native American
      • African American
      • Asian American
      • Children
      • Diversity, Equity & Inclusion
      • Hispanic
      • Lesbian, Gay & Bisexual
      • Men's Interest
      • People with Disabilities
      • Religion
      • Senior Citizens
      • Veterans
      • Women
      • View All People & Culture

  • Hamburger menu
  • Cision PRWeb provides efficient communication tools to continuously engage with target audiences across multiple online channels
  • Create a Free Account
    • ALL CONTACT INFO
    • Contact Us


      11AM ET Sunday – 8PM ET Friday

  • Send a Release
  • Sign up
  • Log in
  • Resources
  • RSS
  • GDPR
  • News in Focus
    • Browse All News
    • Multimedia Gallery
  • Business & Money
    • Auto & Transportation
    • Business Technology
    • Entertain­ment & Media
    • Financial Services & Investing
    • General Business
  • Science & Tech
    • Consumer Technology
    • Energy & Natural Resources
    • Environ­ment
    • Heavy Industry & Manufacturing
    • Telecomm­unications
  • Lifestyle & Health
    • Consumer Products & Retail
    • Entertain­ment & Media
    • Health
    • Sports
    • Travel
  • Policy & Public Interest
  • People & Culture
    • People & Culture
  • Send a Release
  • Sign up
  • Log in
  • Resources
  • RSS
  • GDPR
  • Send a Release
  • Sign up
  • Log in
  • Resources
  • RSS
  • GDPR
  • Send a Release
  • Sign up
  • Log in
  • Resources
  • RSS
  • GDPR

Independent Pharmacies Suffer from DIR Fees; PBM Champions for Change

Lack of accountability and standardization in the assessment of DIR fees contribute to yet another challenge for small independent pharmacies to yield a profit. This could spell disaster for small-town residents and business owners and will be detrimental to entire communities, according to PBM MC-Rx's LaMar Williams.


News provided by

MC-Rx

Nov 12, 2019, 08:00 ET

Share this article

Share toX

Share this article

Share toX

LaMar Williams, Executive Vice President of MC-Rx, is calling for reform in the PBM world when it comes to DIR fees.
LaMar Williams, Executive Vice President of MC-Rx, is calling for reform in the PBM world when it comes to DIR fees.
Youtube
Youtube

GAINESVILLE, Ga., Nov. 12, 2019 /PRNewswire-PRWeb/ -- As more independent pharmacies close or file for bankruptcy across the U.S., industry experts are looking for ways to improve, standardize and make transparent DIR fee calculations as a means to boost pharmacy solvency, particularly in urban and small rural towns, which are being hit the hardest by closures. "It is simply not a good business practice to impose DIR fees on pharmacies without fair negotiation and open disclosure," said LaMar Williams of MC-Rx, a Pharmacy Benefit Manager (PBM) that is calling for reforms. "PBMs are benefiting from these fees, while out-of-pocket costs for prescription drugs continue to go up. Reform and open disclosure will allow pharmacies to measure and manage the DIR fees and better gauge which PBM network they prefer."

Direct and Indirect Remuneration (DIR) represents any money that a Medicare Part D plan that a PBM may collect to offset member costs, including discounts, rebates, coupons, etc. Initially, this was done via a reconciliation between the claim and the negotiated price, or when a pharmacy would pay the PBM in order to participate in a preferred network – a "pay to play" scenario. However, PBMs have begun expanding DIR fees for commercial plans too. DIR fees can be assessed in multiple forms, often unknown to the dispensing pharmacy that is forced to pay PBMs any assessed and arbitrary DIR fee.

"It is simply not a good business practice to impose DIR fees on pharmacies without fair negotiation and open disclosure."

Post this

According to a report in the Journal of the American Medical Association (JAMA), "one in eight pharmacies had closed between 2009 and 2015, which disproportionately affected independent pharmacies and low-income neighborhoods [1]." The same report noted that improvement strategies should include the consideration of "payment reforms, including increases in pharmacy reimbursement rates for Medicaid and Medicare prescriptions," which experts agree is a complex process.

Frequently, the DIR fee is assessed on "pharmacy performance," of which the parameters are unclear, and in many cases, the fee is more than the customer paid for the prescription, creating a scenario in which the pharmacy actually loses money on the transaction. There is currently no legal requirement for PBMs to share their formula for calculating DIR fees.    

A report issued by the Government Accounting Office (GAO) reported that in 2016, PBMs negotiated roughly $18 billion in rebates from drug makers for Medicare Part D plans and passed all but $74 million on to the plan sponsors [2]. The GAO reviewed 20 service agreements between Part D sponsors and PBMs and found the primary source of revenue for PBMs was the volume-based fee paid by plan sponsors based on the number of paid claims the PBM processed. The report found that none of the service agreements tied these fees to the price of a drug paid to the pharmacy.

The cost and use of prescription drugs is expected to continue to rise in the coming decades, as the number of older Americans increases and requires more medical treatment and medication. A report by the Senate Homeland Security and Governmental Affairs Committee found that, on average, prices for the 20 brand-name drugs that are prescribed most often for seniors have increased by 12 percent every year for the last five years [3].

"The unpredictability (of DIR fees) is crushing small, independent pharmacies because they're losing profits and have no way of accurately planning their finances," Williams said. "MC-Rx charges mere cents where other PBMs are charging dollars for these fees, and we include clear statements as to the amount and nature of those fees in the contract with the pharmacy provider. We believe that an open arrangement in which clients and pharmacy partners have access to full claim level reconciliation of their billing and payments is the best way to proceed for all parties in this delivery chain. This must become a standard practice in the PBM industry to protect and facilitate independent pharmacies."

About MC-Rx
MC-Rx is a full-service Pharmacy Benefit Manager (PBM) with corporate offices in Gainesville, Georgia and Caguas, Puerto Rico, with focuses on transparency, best-in-class service, and offering clients "lowest net cost." MC-Rx was formed by combining two URAC-certified, world class PBMs - ProCare Pharmacy Benefit Manager and mc-21. The ProCare companies were founded in 1988 with the vision of providing innovative computer software systems and services to various sectors of the healthcare industry. ProCare processed their first pharmacy claim in 1994 using their proprietary, internally developed and managed systems, and expanded in 1998 to full-service pharmacy benefit management through the acquisition of NextGen PBM. Today, the ProCare companies also include two affiliated mail order and specialty pharmacies, ProCare PharmacyCare, and are one of only four PBM providers that own all of their component systems. MC-Rx now provides comprehensive, industry-leading service to clients in Puerto Rico and the U.S. Visit http://www.mc-rx.com/.

1. "Assessment of Pharmacy Closures in the United States from 2009 Through 2015," JAMA, October 21, 2019
2. "GAO Highlights," Government Accounting Office, July 2019
3. "Manufactured Crisis; How Devastating Drug Price Increases Are Harming America's Seniors," US Senate Homeland Security & Governmental Affairs Committee, September 2017

SOURCE MC-Rx

Related Links

http://www.mc-rx.com

Modal title

LaMar Williams, Executive Vice President of MC-Rx | Photo
LaMar Williams, Executive Vice President of MC-Rx | Photo
MC-Rx | Company Logo
MC-Rx | Company Logo
LaMar Williams, Executive Vice President of MC-Rx | Photo MC-Rx | Company Logo

Contact PRWeb

  • 11AM ET Sunday – 8PM ET Friday
  • Contact Us

About PRWeb

  • About PRWeb
  • Partners
  • Partnership Programs
  • Editorial Guidelines
  • Resources

Why PRWeb

  • Why PRWeb
  • How It Works
  • Who Uses It
  • Pricing

Accounts

  • Create a Free Account
  • Log in
  • Contact Us

Do not sell or share my personal information:

  • Submit via [email protected] 
  • Call Privacy toll-free: 877-297-8921

Contact Cision

Products

About

My Services
  • All News Releases
  • Online Member Center
  • ProfNet
Cision Distribution Helpline
888-776-0942
  • Legal
  • Site Map
  • RSS
  • Cookie Settings
Copyright © 2025 Cision US Inc.