CMS issues revised guidance to Medicare Drug Price Negotiation Program

NCPA July 5, 2023

CMS recently issued revised guidance to Medicare Drug Price Negotiation Program. CMS noted that the majority of the comments received from supply chain entities on this topic, including manufacturers and pharmacies, supported the use of a standardized, published pricing metric to calculate the refund due from the manufacturer to the pharmacy for the pass through of the maximum fair price as required under the program. NCPA had similarly supported the use of WAC in its comments to the initial guidance in April. CMS plans to provide further information regarding this topic in technical guidance before initial price applicability year 2026. Addressing NCPA’s concerns about financial viability of the model for pharmacy, CMS stated that plan sponsors retain flexibility in determining the fees paid or charged to pharmacies, including dispensing fees. However, CMS reaffirmed its commitment to prompt pay requirements. Stay tuned to qAM for more.