What DIR fees are
DIR stands for direct and indirect remuneration. It is the Part D category for money that changes a drug's final cost after the sale, including manufacturer rebates and pharmacy price concessions. In pharmacy talk, DIR fees means the pharmacy side. These are amounts plans and PBMs take back, often based on performance metrics like adherence.
Before 2024, many of these fees were assessed months after a claim was paid. A pharmacy could not see its real margin at the counter. CMS rule CMS-4192-F changed that. Starting January 1, 2024, plans must apply all pharmacy price concessions to the negotiated price at the point of sale. The negotiated price is now the lowest possible payment.
Point-of-sale concessions removed the surprise but not the pressure. Many network contracts still tie pharmacy payment to performance scores such as adherence on statins, diabetes drugs, and blood pressure drugs. Rivvi is a HIPAA-compliant AI workspace where owners can analyze fill and performance files in chat. Its action layer runs refill outreach by call and text.