The Senate is continuing negotiations on the Inflation Reduction Act, and the current draft bill includes provisions that should impact community pharmacy. Starting in 2026, HHS would negotiate pricing for 10 top-spend drugs in Medicare Part D, many of which are dispensed in community pharmacy, and would increase yearly and include Part B drugs by 2028. For pharmacies, reimbursement could be impacted under the new framework, as any difference between the negotiated price and discounted price for a drug would be “trued-up” within prompt pay requirements. NCPA has pushed for protections for pharmacy payment, advocating that no reduction in pharmacy reimbursement would occur because of Medicare drug price negotiation. The legislation would also cap out-of-pocket costs for Medicare Part D beneficiaries at $2,000 per year. It remains to be seen if insulin reform will be included, which may include capped copays; however, there is a strong indication this will be the case. Current negotiations also include a repeal or further delay of the drug rebate rule, which Democrats are using once again as a budget gimmick to offset cost of the legislation.
NCPA
