Under the Medicare Drug Price Negotiation Program (MDPNP),
starting this month, the secretary of the Department of Health
and Human Services (HHS) has negotiated pricing for the 10 top-
spend drugs in Medicare Part D, and will increase the number
of drugs negotiated yearly and include Part B drugs by 2028.
This is a cumulative list, and should result in 60 negotiated drugs
by the end of the decade. This means that effective January 1,
2026, 10 drugs covered under Medicare Part D now have
negotiated prices, which the law refers to as maximum fair prices
(MFPs). The Centers for Medicare & Medicaid Services (CMS)
expects the savings realized in 2026 to lower out-of-pocket costs
for Medicare enrollees by an estimated $1.5 billion.1
Community pharmacies are critical to ensure the success of the
MDPNP. A study by Avalere Health in March 2025 showed
the impact of the MDPNP on independent pharmacies and
beneficiaries alike. The study found that 34% of prescriptions (or
74 million prescriptions) slated for the MDPNP for 2026 or 2027
are currently filled at an independent or franchise pharmacy.
Avalere defined franchise pharmacies as “independently owned
pharmacies that operate under a franchisor’s branding and
business model within a specific region.” Additionally, the report
found that 30% of Medicare Part D beneficiaries (or 12 million
beneficiaries) received at least one of these prescriptions at an
independent or franchise pharmacy. The study concluded that
it is vital to understand impacts on dispensers and beneficiaries.2
The MDPNP is expected to exacerbate cash flow concerns
that pharmacies already have under Medicare Part D. Under
Medicare Part D, on average independent pharmacies are paying
their wholesalers for drugs they ship to pharmacies approximately
every two weeks, with some paying more frequently. Meanwhile,
plans and PBMs under Medicare Part D must reimburse
network pharmacies (other than mail-order and long-term care
pharmacies) under Medicare Part D prompt pay requirements 14
days after which the claim is received for electronic claims, and 30
days after for any other claim.3
But a study published in January 2025 by 3Axis Advisors
and commissioned by the National Community Pharmacists
Association (NCPA) has projected that pharmacies can expect
to experience additional financial strain under the MDPNP.
The 3Axis Advisors study found that: 1) pharmacies can expect
to face prescription payment settlement delays (in the form of
the manufacturer refund payments) of at least seven additional
days for negotiated drugs, exceeding current Medicare Part
D prompt pay requirements; 2) each pharmacy stands to lose
nearly $11,000 in weekly cash flow due to delayed payments;
and 3) pharmacies could forfeit an average of $43,000 in annual
revenue — roughly equivalent to a pharmacy technician’s
yearly salary. The projected $43,000 annual loss is due to the
elimination of estimated margins previously yielded on MFP
medications relative to estimated MFP-based payments.
And community pharmacists have concerns with the program.
In September 2025, NCPA surveyed its members on the
MDPNP, and received slightly over 400 responses. When asked
if the MDPNP would affect their decision to stock these ten
drugs, 86% stated that they were either considering (67%) or
have already decided (19%) to not stock the drugs.4
Pharmacies
Concerned
with the
Medicare
Drug Price
Negotiation
Program
Contributed by, Steve Postal, Senior Director,
Policy and Regulatory Affairs at National
Community Pharmacists Association (NCPA),
and Editorial Director of American Society for
Pharmacy Law (ASPL)
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