DIR Mitigation During Open Enrollment

When it comes to DIR fees, pharmacies have a number of options they can employ to mitigate them. Tactics could look like focusing on outliers early in the year or improving pharmacy performance on specific metrics. During Open Enrollment, there is also an opportunity to tackle DIR fees via an approach called “DIR Mitigation by Migration.” The DIR Mitigation by Migration strategy focuses on reducing the effect of DIR fees by identifying opportunities to simultaneously improve adherence scores and help patients save money. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Here’s how it works: Certain plans have rebate incentives in place for DIR fees collected from the pharmacy. These plans need to be weighed at the store level and not the PSAO (read more about this here). Using Amplicare, you can identify patients who are habitually non-adherent and on one of these plans. If their cheapest plan option next year doesn’t have adherence as a metric, or it is weighed at the PSAO level, it’s recommended that the patient switch to that plan. It also works the other way, i.e., if patients are adherent and on a plan that doesn’t reward the pharmacy for their good adherence. 

Is the DIR Mitigation by Migration strategy effective? According to Blake Wiseman, owner of J&R Pharmacy in Benton, KY, this approach has helped his pharmacy deal with DIR fees. “We got a nice big check this year from one of our payers for hitting the rebate criteria,” he says. “I’m helping my patients save money, and increasing our performance in plans that will result in bonus payments. This is an entirely new way to look at tackling DIRs.”

Watch the video above to hear Wiseman explain how the strategy works and the benefits he has seen for his business. 

To learn more about this and other DIR mitigation tactics for Open Enrollment, download our DIR Fees 101 guide or reach out to us to schedule a consultation.