Net reimbursement after DIR is the number every independent pharmacy owner wishes they could see at the point of sale — and can't. The dispensing software shows the claim as adjudicated, but DIR and GER fees claw back a slice retroactively, sometimes months later, so the only honest measure of profit is net reimbursement reconciled against the wholesaler's acquisition cost. This dashboard does that reconciliation continuously, turning the after-the-fact Excel exercise into a live margin view.
What this report answers
Did each script make money once the PBM was finished with it? The Margin Reconciliation page carries the six headline KPIs — net reimbursement, gross profit, net margin rate, total acquisition cost, DIR/GER fee drag, and claim count — and anchors them with a waterfall that walks from gross reimbursement, subtracts DIR/GER fees, subtracts acquisition cost, and lands on gross profit. A line chart trends net reimbursement against gross profit by fill month so you can see whether margin is eroding even as revenue holds.
The metrics that matter
Net margin rate is the headline: gross profit divided by net reimbursement tells you how many cents of every reimbursed dollar you actually keep after drug cost. DIR/GER fee drag is the silent line — the retroactive clawback that separates the point-of-sale number from reality. The Per-Script Detail page plots net reimbursement against acquisition cost for every claim, so any point below the break-even diagonal is a script dispensed underwater, and an NDC-grain table ranks where the profit (and the loss) concentrates.
Why the data is trapped across the systems
No single system holds this number. Your dispensing platform — PioneerRx, BestRx, or QS/1 — records the fill and quantity. The PBM remittance (835 or CSV) records what was actually paid and, eventually, the DIR/GER adjustment. The wholesaler portal (McKesson, Cardinal, or AmerisourceBergen) holds acquisition cost at the NDC level. Margin only exists once all three are joined, which is why owners reconcile by hand and learn about a below-cost month after it's over.
How to read it
Start with the waterfall: the gap between gross reimbursement and gross profit is your true cost of doing business, and the DIR/GER segment is the part you can fight with payer mix and contract decisions. Then read net margin by drug class to find where margin is thin, and use the per-script scatter to spot the underwater claims feeding the Below-Cost Claims report. Watch net margin rate over time — a slow decline usually means DIR drag is rising faster than reimbursement.
The sample here uses entirely synthetic claims, costs, and remittances — no real PHI or payer data.
Metrics it tracks
| Metric | What it means |
|---|---|
| Net Reimbursement | Net dollars the PBM/payer actually paid per claim, after all retroactive DIR/GER fees and reversals. |
| Gross Profit | Net reimbursement minus wholesaler acquisition cost, summed across dispensed claims. |
| Net Margin Rate | Gross profit ÷ net reimbursement — the share of every reimbursed dollar kept as profit after drug cost. |
| Total Acquisition Cost | Wholesaler acquisition cost of the drugs dispensed across all claims. |
| DIR / GER Fee Drag | Retroactive DIR and GER clawback fees deducted from gross reimbursement. |
| Claim Count | Dispensed-and-reconciled claim rows in the period. |
Used by: Owner-pharmacists and pharmacists-in-charge reconciling true profit per script after remittances post
Frequently asked questions
Why can't I see true per-script margin at the point of sale?
Because DIR and GER fees are assessed retroactively. The claim adjudicates at one amount, then the PBM claws back a fee weeks or months later. True net reimbursement — and therefore true margin — only exists once the remittance posts and you net out those fees against the wholesaler's acquisition cost.
What is DIR/GER fee drag and why track it separately?
DIR (Direct and Indirect Remuneration) and GER (Generic Effective Rate) fees are retroactive deductions PBMs take from your gross reimbursement. Tracking the drag as its own line shows how much of your gross is being clawed back — the difference between the profit you booked at the counter and the profit you actually keep.
Can I build this on my own remittance and cost data?
Yes. Export your dispensing data, your PBM remittances (835 or CSV), and your wholesaler acquisition cost, and use this as a template — we join and model them into a Power BI report you open in Power BI Desktop. The sample uses synthetic data so you can see the finished layout first.
Build this report on your own data
Clone this Independent pharmacies template — describe it and we’ll generate sample data so you can try it free, or upload your own export. You get a fully modeled, branded Power BI project that opens in Power BI Desktop.
Use this as a template →