DIR fees, or direct and indirect remuneration fees, are collected after pharmacies fill a prescription for Medicare recipients. These fees led to the owners of Osterhaus Pharmacy, the plaintiff, to shutter operations in January 2022, according to the lawsuit.
Osterhaus accused UnitedHealth Group; its insurance company, UnitedHealthcare; and its PBM, Otpum Rx, of forcing independent pharmacies to close by “unlawfully extract[ing] huge sums of money” with DIR fees.
These costs “coerce pharmacies to produce outcomes over which they have little or no control” with “a ‘take it or leave it’ package,” the plaintiff said. “Independents cannot afford to push back against OptumRx because they risk losing access to beneficiaries. The opposite is not true — OptumRx can steer and prefers to steer patients to its own mail‐order pharmacy. To be sure, community members suffer as a result — from losing pharmacy services or receiving inadequate services.”
Becker’s has reached out to UnitedHealth Group and will update this story if more information becomes available.
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