Survey: Independent pharmacies worried about ‘DIR hangover’

ALEXANDRIA, Va. – Seventy percent of independent community pharmacy owners/managers are concerned about upcoming cash flow challenges resulting from changes to federal policy effective Jan. 1, 2024, according to a new survey released by the National Community Pharmacists Association. 

The NCPA asked independent pharmacy owners/managers for insight relating to the “DIR hangover” – what it calls the period starting Jan. 1, 2024, when bills for pharmacy direct and indirect remuneration for the end of 2023 will come due to pharmacy benefit managers, just as those DIR fees for the beginning of 2024 will be moved to the point of sale. The “DIR hangover” is a result of provisions from CMS’s Medicare Part D final rule for contract year 2023 going into effect. 

“With pharmacy benefit manager pressures and other economic issues at play, it continues to be a challenging environment in which to operate an independent pharmacy,” said Anne Cassity, senior vice president of government affairs at NCPA. “Under pressure from regulators and policymakers to straighten up, PBM insurers are in overdrive trying to make people believe they don’t need oversight or reforms, while seemingly carrying on with tactics that make it difficult for patients to access care and independent pharmacies to remain healthy. Without hard results, their promises are empty. Work must continue to advance changes that demonstrably support pharmacy teams, the patients they serve, and the supply chain we all rely on.”  

Ninety-eight percent of survey respondents say they are concerned about the upcoming “DIR hangover” and how it will affect their pharmacy; a majority (70%) say they’re very concerned. 

Eighty-five percent of respondents say they are taking steps now to prepare. When asked to select ways they are preparing, respondents most commonly reported putting aside cash for estimated DIR (64%), exploring loan opportunities to get through the “hangover” period (42%), updating technology and leveraging pharmacy software systems to help predict reimbursements (28%), and working with consultants (23%).