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Upcoming DIR Fee Changes Still Causing Concern for Pharmacists

By this point, pharmacists are well aware of the direct and indirect remuneration (DIR) fee changes that will be implemented at the start of 2024: The Center for Medicare and Medicaid Services (CMS) has issued a final rule eliminating pharmacy benefit managers (PBMs) retroactive application of DIR fees, requiring instead that these fees are reflected in the negotiated price the patient pays at the pharmacy counter. The belief by CMS is that it will create greater transparency for patients and pharmacies—though not everyone is excited about the change.


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