NCPA submitted comments to CMS in which we urged the agency to implement the Medicare Drug Price Negotiation Program (MDPNP) in a way that doesn’t harm independent pharmacies or patient access. In the MDPNP, HHS will negotiate with manufacturers a “maximum fair price” (or MFP) for 10 drugs in Medicare Part D beginning in 2026, and additional drugs in Part D and Part B in subsequent years. In the comments, NCPA hopes that the launch of the MDPNP will avoid a similar shock to independent pharmacy that occurred in January 2006 with the launch of the Medicare Part D program, which had significant negative effects on independent retail and long-term care pharmacies.
NCPA’s analysis of 5,200 community pharmacies to determine the effect of MFP drugs on community pharmacies found that if the MFP rebate reaches 60 percent of the acquisition cost, the average pharmacy will have to float over $26,000 every month waiting to be made whole. The effect on independent pharmacies’ cash flow, collectively, will be a half billion dollars every month. This huge number is only for the first year of the MFP program; it will grow larger and larger as more drugs are added each year, resulting in devastating, irreparable harms on pharmacies serving the most vulnerable and at-risk patients, especially those serving LTC facilities.
To preserve patient access to MFP drugs under this program—and see that pharmacies are paid promptly and aren’t floating the program—NCPA’s comments urged CMS to verify and ensure the following, among other asks:
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That PBMs and plans should not be able to impose any pharmacy price concessions that would ultimately reduce patient access to MFP drugs.
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That pharmacy reimbursement will incorporate 1) a negotiated price that is no lower than the maximum fair price and; 2) cover acquisition cost plus commensurate professional dispensing fee in line with Medicaid fee-for-service, and be paid within Medicare prompt pay requirements.
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That the Medicare Transaction Facilitator (MTF) generates an Electronic Remittance Advice, or 835, to the pharmacy for purposes of reconciling manufacturer retrospective MFP refunds.
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That neither plans, PBMs, manufacturers, wholesalers, CMS nor any other entity assess any fee on pharmacies to effectuate the MTF or any aspect of the MDPNP whatsoever, and that any Electronic Funds Transfer fees should be borne by the manufacturer and not the pharmacy.
