30 Days of US Healthcare: DIR Fees
About this video
This 30 Days of US Healthcare sketch sets a med student with a community pharmacist who explains DIR fees while showing them the pharmacy. Flanary portrays pharmacy benefit managers as clawing back reimbursement months after prescriptions are dispensed, based on performance metrics they refuse to disclose, with refusal meaning exclusion from the network. The pharmacist says the fees have grown enormously since 2010, that he loses money on nearly every prescription, and answers the question of how independent pharmacies survive by saying they do not.
Key takeaways
- Flanary describes DIR fees as retroactive PBM clawbacks taken months after dispensing
- His point is that the performance metrics behind the fees are kept secret from pharmacies
- The sketch argues fees can exceed the margin on a prescription, making most fills money-losers
- Network exclusion is presented as the threat that forces pharmacies to accept the terms
Episode details: published September 23, 2023 · 166.4K views · 2:23 long. Summary written by Self Growth Videos from the episode itself. Everything described is Dr. Glaucomflecken’s (Will Flanary, MD) satire and commentary on the US medical system, attributed to him as satire — his sketches are comedy, not documentation, and this is not medical advice.
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