Here’s the Rundown on DIR Fees

Pharmacists and owners know about DIR fees and the dangers it means for retail pharmacies. But for most of the world, the term “DIR fees” sounds like another industry buzzword. One of our PDS members, Traci Shell from Corner Drug Store in North Carolina sent us a summary that was so spot-on and well written, we had to share it.

BONUS: Look below for an easy download of this summary and a breakdown of DIR fees per PBM.

Hidden DIR Fees

You can share this with…

  1. The team at your next team meeting (that’s what Traci did!), so they can stay current with the issues your pharmacy faces and understand that the goals you set are around combating these fees. Read below to learn how pharmacies like you are making them irrelevant.
  2. Elected officials so they can begin to comprehend the plight of the independent. The more they understand the gravity, the greater the chances to spur legislation that drives real change in the industry.

What are DIR Fees?

DIR stands for Direct and Indirect Remuneration. In a nutshell, these are fees paid back to the PBM (pharmacy benefit manager) after the point of sale transaction or time of adjudication. Fees are typically collected at the time of third-party payment. However, some are taken far past that date. The fees discussed below and detailed on the second page only apply to Medicare Drug Plans.

What Does this Mean for Independent Pharmacies?

What makes DIR fees so “dangerous” is the fact that they are not easily identifiable at the time a claim is processed. This pain point is exaggerated by the fact that these fees vary by not only the PBM, but by the drug, the pharmacy, and by performance.

It’s not expected for EVERYONE to know EVERYTHING about these fees. However, it is crucial that their existence is acknowledged. Each day we encounter low or below-cost reimbursement by PBMs. We are forced to determine how little we are making on that claim or how much we are losing.

The Problem with PBMs 

Many times, a prescription is sent through under the assumption that we’re “only losing $2,” or, “at least we’re making $1.” The problem with this thought process is a failure to calculate in the DIR fee the PBM will expect to be paid. Often after assessing the estimated DIR fee, that small “profit,” is now a loss.

Up until this point, most were completely unaware of these fees. While DIR fees have been around since 2006, it wasn’t until 2013 when they began to show up in PBM’s pharmacy contracts. Since that time, DIR fees have gradually grown, evolved, and become the monster we can no longer hide in the closet.

How Independent Pharmacies Can Combat DIR Fees

While this summary may seem dark, there is hope! Pharmacies just like you around the country are discovering ways to undermine the cost of these fees on their business. It's not luck that makes a pharmacy successful. It's not even one single strategy, applied well. It is a combination of unique variables that sparks the development and profitability of your pharmacy while providing a system to sustain the growth.

After 20 years, and through a relentless mission to help pharmacies maximize their potential, PDS has identified these 4 "it" factors for pharmacy success.


Your business is nothing without a high-performance team to align with your vision as a leader. Too often, owners are mired in the chase for more profits that they forget the bedrock of their business: their people. A successful owner sets forth a plan to hire and train the right people and focuses on culture to engage their team. You will be unstoppable with an empowered staff that is powering on all cylinders. Keep in mind, people work harder when they know they are valued, appreciated, and set up for success.

Four Foundations of Successful Pharmacy Ownership


Pharmacy owners too often think that the variable to achieve pharmacy profitability is volume. They would be mistaken. Long gone are the days when pharmacies have to settle for every prescription that walks through the door. It is vital for owners to shift their mindset on what will move the needle in their business. For example, ask yourself which prescriptions are making the most money? The least? It’s critical to identify where you are making money - and doing more of that - and where you are losing money - and doing less of that. Your success should not be measured by script volume, but rather, profit per script. Would you rather fill 100 $4 prescriptions or four prescriptions with a $100 profit each? Which requires more effort?

This is only one of the many ways to impact your profitability. PDS has identified many ways to increase your profits. ​Find out more here.


Resting on your past successes is a prescription for failure. Doing something because you've always done it will cost you valuable time, money and resources. Ask yourself: is every corner of your business operating at peak performance? Auditing how your pharmacy works, from your workflows to your inventory will show you the changes you need to make to maximize efficiencies in your pharmacy. Do your employees adhere to structured systems and processes that set them up for success and smooths operations? Do you have a handle on your inventory so you're not allowing any stockpiling? Are you managing your will-call bins? Do you have expired or dead products? These are all questions to ask yourself as you look around your pharmacy.

Every corner of your business can benefit from a good audit. The key is to audit consistently and implement process change swiftly before you lose any more valuable resources.


Pearson's Law: Everything measured improves, and everything measured and reported on improves exponentially.

This factor in pharmacy success is all about numbers. Understanding your numbers will help you identify and set your goals and listen to what the data is saying to make informed decisions. It's how you measure whether or not your pharmacy is on the right track towards achieving your goals. Are you financially literate? Do you know how to read, understand and interpret your financial statements along with other pharmacy data to help you make better management decisions, course-correct and seize opportunities? If this is an area in your pharmacy you are falling behind on, it's vital for you to secure the right tools and resources to help you become literate in your business so you can measure profitability and growth in your pharmacy. (Hint: PDS can help!)

Download the DIR Fee Summary and Estimate Cost per PBM

Fill out the form below to download the summary and don't forget to share it with your team and your elected officials!