Maximum (Un)Fair Price
How pharmacies will pay for the Medicare Drug Price Negotiation Program
On January 1, 2026, ten of the most widely used and expensive brand drugs in Medicare will be placed into their own acquisition and reimbursement system, known as the Medicare Drug Price Negotiation Program (MDPNP).
Recently, CMS created guidance for this program, which will ultimately result in a system where a pharmacy’s reimbursement for these ten drugs is capped at the acquisition cost of the drug, resulting in a maximum gross profit of zero dollars or worse. This could drive pharmacies out of Medicare altogether and severely undercut patients' ability to receive the medications they need.
CMS's Faculty Guidance
Pharmacy's Max Profit Will Be Zero: The Part D plans' maximum reimbursement is the drug's Maximum Fair Price; the drug maker's maximum access payment is the WAC price minus the MFP; therefore, a pharmacy's maximum gross profit will be zero dollars or worse.
Slow Pay: The drug maker can make the access payment up to 44 days after claim adjudication; the average pharmacy will carry a new perpetual receivable of $27,000.
Who We Are
American Pharmacies, a cooperative of over 700 independent pharmacies across the country, has a robust independent pharmacy advocacy mission. We have been closely monitoring the MDPNP and are alarmed at how harmful the MDPNP will be for the independent pharmacy community and the Medicare patients they serve.
To read these stories and more, download the PDF of the Total Pharmacy February issue here.
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