We have several reports from our member pharmacies that the PBM with BIN 610097 is rolling out a new DIR fee program tied entirely to Hypertension (RASA - Renin Angiotensin System Antagonists) adherence.
These new DIR fees are effectively a hybrid of two popular DIR formats: a retroactive flat DIR, only later “refunded” if certain performance measurements are obtained.
Here is a brief breakdown of these pharmacy star ratings:
-The PBM withholds a fee of $8.75 for every Medicare prescription at remittance
-Then, RASA adherence is calculated on a PSAO level
-Then, the PBM refunds pharmacies between $0-8.75 based on hypertension adherence performance
What can you do about this?
Dual Eligible patients can switch plans at any point during the year!
iMedicare provides members with a list of your affected dual eligible patients on BIN 610097 by clicking here: https://app.imedicare.com/opportunities/dual-eligible?search=610097
Join our efforts to create an independent-owned Medicare Part D plan.
Looking to improve your adherence measurements and lower DIRs? iMedicare is introducing our adherence and MTM platform.
Using a proprietary machine learning algorithm that detects patients’ current plan and subsidy, we will identify the patients with the greatest impact on your DIRs and the actions you can take to improve your performance measurements today.
For all those patients on RASA medication billed to BIN 610097, you can easily target those who will decrease your DIR fees.