NCPA Unveils an Opportunity to Fight Back Against DIR Fees

Pharmacists wronged by PBMs and big insurance companies can get an opportunity to fight back by joining new trust to recover DIR fees

NCPA October 16, 2023

ORLANDO, Fla. (Oct. 16, 2023) – The National Community Pharmacists Association on Sunday announced a major new legal initiative for pharmacies that have been victimized by the unconscionable behavior of the largest pharmacy benefit managers that NCPA says have made billions in back-end penalties in violation of the law.

“PBMs shouldn't be able to make assessing junk DIR fees against competing pharmacies a multi-billion dollar cottage industry that puts their competition out of business and compromises patient care,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “It’s completely anti-competitive, and we’re fighting back.”

NCPA is creating a limited liability company, called TRUST LLC, which will investigate and, when appropriate, litigate or arbitrate on behalf of community pharmacies to recover coerced price concessions, otherwise known as pharmacy direct and indirect remuneration fees. NCPA believes DIR fees were assessed by the PBMs and insurance plans in violation of federal antitrust law and state contract laws. It’s the second major legal effort announced in the past several weeks. In September, the group applauded a class-action lawsuit against CVS Health, CVS Caremark, and Aetna brought by an independent pharmacist from Iowa who is also a member of NCPA.

“These companies have nearly unlimited resources and it’s almost impossible for a single independent pharmacy to fight them alone. The way the contracts are set up, arbitration for claims like these can top $1,000,000 for a single pharmacy. NCPA’s efforts allow independent pharmacies to assign their claims to TRUST LLC to fight the PBMs together,” said Hoey. “It’s still not an even playing field, but we have a much better chance of getting justice if we join forces.”

TRUST LLC has retained the law firms of Berger Montague PC, Cohen & Gresser LLP, and Baker Donelson to lead the litigation. Berger Montague and Cohen & Gresser are the firms that filed the class-action lawsuit against CVS Health in federal court last month.

“Community pharmacists are indispensable providers of health care in communities across the United States,” said Katie Funk, a partner with Baker Donelson. “We look forward to working with NCPA to expose the unconscionable PBM practices that are driving up costs, eliminating patient choice, and driving community pharmacies out of business.”

NCPA made the announcement at its annual convention, this year taking place in Orlando, Fla. To learn more about the TRUST, please visit


Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing over 19,400 pharmacies that employ more than 230,000 individuals nationwide. Community pharmacies are rooted in the communities where they are located and are among America’s most accessible health care providers. To learn more, visit