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Using automation to fight DIR fees.

Direct and Indirect Remuneration (DIR) fees are crushing independents. The only defense is maintaining exceptional Proportion of Days Covered (PDC) scores. Here is the automated playbook.

The PDC Battleground

PBMs claw back your margins based on patient adherence metrics, specifically focusing on three key therapeutic classes:

  1. Statins (Cholesterol)
  2. RAS Antagonists (Hypertension)
  3. Non-Insulin Antidiabetics (Diabetes)

To avoid the highest penalties, your pharmacy typically needs patients to have the medication on hand ≥80% of the time. Doing this manually via outbound phone calls is a losing battle against labor costs.

The Manual Approach

A technician prints a list of patients who are late to refill, dials each one manually, leaves a voicemail for 70% of them, and spends 5 minutes talking to the other 30%.

Cost: High labor, low success rate.

The RxHello Approach

RxHello queries the PMS for patients in the targeted therapeutic classes who drop below an 85% PDC threshold. It sends a customized SMS. The patient replies "YES". The system queues the refill.

Cost: Zero incremental labor.

The Med Sync Synergy

Medication Synchronization (Med Sync) is the holy grail of adherence, but enrolling patients is tedious. RxHello handles the top-of-funnel enrollment.

When a patient requests a refill for a maintenance med, the AI checks if they have other active maintenance scripts. If so, it suggests syncing them:

"I see you also take Metformin and Amlodipine. Would you like us to align your refill dates so you only have to visit the pharmacy once a month? Reply SYNC to have a pharmacist set this up."