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Chain Drugstore Daily Sunday, April 22, 2018 1 0 Responding Effectively to the Challenge of DIR By Lari Harding, Vice President, Product Marketing and Chris Smith, Director, Pharmacy Business Intelligence While the Centers for Medicare and Medicaid Services (CMS) created Direct and Indirect Remuneration (DIR) with the best of intentions, the actual results have been anything but good for pharma- cies. Created to increase visibility, ensure accuracy and reduce costs, DIR has unfortunately mutated into a layered labyrinth of costly post-adjudication financial assessments imposed by PBMs on pharmacies – creating a substantial and growing financial burden on pharma- cies that is threatening their survival. Understanding the Impacts Since its inception, DIR has been increasingly and negatively impacting pharmacy financial operations. So much so that today, a typical pharmacy has between $50,000 and $100,000 at risk due to DIR. With the proliferation of DIR across the Part D landscape and the intro- duction of new service fees, the percent- age of sales represented by these two "liabilities" grew 50 percent between Q4 2016 and Q4 2017, increasing from 0.97 percent to 1.44 percent. DIR alone, as a percentage of sales, crossed the 1 percent threshold in the second half of 2017 and by Q4 2017 was at 1.14 percent of sales. Addressing an Uncertain Future The costs associated with DIR will only grow if the practice is left unchecked. However, there may be some eventual relief as there are four bills currently in committee in Congress aimed at either increasing transparency around the practice or pro- hibiting it altogether. Regardless of what the future brings, there are resources already available from Inmar that pharmacies can leverage to better address DIR and lessen the related operational pressures. Inmar has the tools pharmacies need to analyze DIR, predict profitability and develop strategies for improving business results. These tools provide the means for pharmacies to 1) minimize the resources committed to matching claim- level data back to carrier sales, 2) avoid any number of costly financial missteps and 3) free up personnel to pursue inter- nal KPIs and focus on direct bottom line- building activities. As DIR is often assessed weeks or even months after a prescription has been filled, pharmacies are frequently prevent- ed from knowing at the time of dispens- ing what their true reimbursement will be for that prescription. With Inmar's help, pharmacies can understand clearly how assessments will be made, when they'll be invoiced and which measurement cri- teria will be used by plans and PBMs to set DIR fees. Pharmacies using this Inmar- enabled insight are much better positioned to negotiate more favorable reimbursement terms. Finding Solutions for Improving Outcomes Inmar is committed to working with our clients, government and the industry to find a way to achieve the real purpose behind DIR – establishing payment based on value rather than volume. While we are already delivering solutions for solid financial management to our phar- macy clients, Inmar is also collaborating with industry allies to develop business models that will lower costs for the gov- ernment, employers and patients, and improve health outcomes. We are learn- ing, experimenting and innovating and we want you to join us! Visit Inmar at table #430. For more infor- mation, go to www.inmar.com. Camber Launches Products from New Long Island Facility Hetero Drugs' new 310,000 square foot U.S. manufacturing facility, Ascent Pharmaceuticals, in Central Islip, New York, has recently opened with four new product launches, including: Oxycodone HCl Oral Solution, Oxycodone APAP, Methylphenidate Oral Solution and Dutasteride. Another six new product launches made up mostly of controlled substances are on the way for the remainder of the year. These products include Oxymorphone IR Tablets, Hydromorphone Oral Solution, Hydromorphone Tablets, Methylphenidate Chewable, Dronabinol Capsules and Bexarotene Capsules. Camber's current portfolio includes 48 products (164 SKUs), 43 of which are manufactured by Hetero Drugs and five manufactured by Ascent Pharmaceuticals. Camber's future pipeline includes 55 ANDAs filed/under review and 15-plus ANDAs projected for release in 2018. With well over 1 million square feet of new manufacturing and warehouse space added in India and its new U.S. facilities, Hetero now has more than 2.5 million square feet dedicated solely to the U.S. market. Plus, it is more than 90 percent vertically integrated on all its products. Hetero is one of India's leading generic pharma- ceutical companies and the world's largest producer of anti-retroviral drugs for the treatment of HIV/AIDS. Backed by over 20 years of expertise in the pharmaceutical industry, Hetero's strategic business areas spread across APIs, generics, biosimi- lars and custom pharma- ceutical services. The company is globally rec- ognized for its strengths in research and develop- ment, manufacturing and commercializa- tion of a wide range of products. Hetero has 33 state-of-the-art manufacturing facilities strategically located worldwide. Visit Camber Pharmaceuticals at table #534. For more information, contact Megan Becker at 732.529.0436 or by email at mbecker@camberpharma.com, go to www.camberpharma.com or call 732.529.0430. Baking Mixes from the Heartland By Lorrie Baumann Montana Grassland Mixes offers a line of salad dressing and baking mixes based on authentic recipes from hunting camps and home kitchens of Montana. The product line includes Garden Gate, a salad dressing and dip mix that was Founder and co-Owner Patsy Tihista's first creation for the commercial market; Stone Trapper Frybread Mix; Justice Coulee Biscuit Mix; Porcupine Creek Pancake Mix and Prairie Walker Sweet Bannock Bread Mix and Prairie Walker Savory Bannock Bread Mix. Each of these products represents a lifestyle: "When you cook at home in the country," Tihista says. "These things are just the way we cook here.... They're all extremely easy. The fry bread takes a cup of water. The bannock takes a cup of milk, and the others are easy too." She started her product line six years ago at home in her kitchen with a salad dressing that comes from a mix of herbs and spices that she originally just whipped up in a jar with some mayon- naise. Her friends and neighbors loved it, so she started mixing up the dry ingredi- ents and dosing them out into plastic bags that she'd sell at the local farmers mar- ket. When she started branching out, she asked her Montana family for recipes. Her dad brought the recipe for the ban- nock bread back from a hunting trip. "They just put that in a frying pan and backed that up to the campfire, and that's how they had bread at the hunting camp," Tihista says. Once she had the recipe in her hands, she developed varia- tions for sweet, which has cinnamon in it, and savory, which offers garlic and herbs. Her business has grown out of her home kitchen, but every batch of her mixes is still made by hand by Tihista herself. Her Stone Trapper Frybread Mix is her best seller. "If we go to shows and cook the fry bread, which we do, we just sell a whole lot of that," she says. The frybread, a traditional favorite across the West, can be cooked in a deep fryer, but a deep skillet with enough high smoke-point oil in it to cover the bread dough will work just as well, according to Tihista says. "You run that up there pretty hot," she notes. The bannock bread dough is tradi- tionally cooked in a cast iron skillet over the campfire or in the oven, but it'll also cook on a sheet of aluminum foil laid over the barbecue grill, she says. "If you come home at 5:30 and want hot bread at 6:00 for supper, you can have it, because it just takes 20 minutes," she says. "They're not as easy as grabbing a loaf of bread off the shelf, but they're close – and you have hot bread." For more information, call 406.785.2321 or visit www.montanagrasslandmixes.com. Gift-boxed assortments are available.