CMS released the negotiated prices of the 10 drugs in the Medicare Drug Price Negotiation Program in Medicare Part D, effective CY 2026, that CMS has negotiated with manufacturers. These negotiated prices are referred to as maximum fair prices. These include, for a 30-day supply: Januvia ($113.00); Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill ($119.00); Farxiga ($178.50); Enbrel ($2,355.00); Jardiance ($197.00); Stelara ($4,695.00); Xarelto ($197.00); Eliquis ($231.00); Entresto ($295.00); and Imbruvica ($9,319.00). For details from CMS, see here and here. CMS will announce the selection of up to 15 additional drugs covered by Part D for the second cycle of negotiations by Feb. 1, 2025.
NCPA has updated talking points on the MDPN Program, including our concerns that pharmacy will have to float the program and shoulder an increasing burden; that pharmacy will not be paid fairly by PBMs; and that manufacturer refund payments to pharmacy will be delayed. Among other things, we advocate that CMS must require Part D plans and PBMs to pay pharmacies no less than the MFP plus a commensurate dispensing fee when providing these drugs to patients, and that CMS should mandate that PBMs cannot assess DIR fees on these drugs.
In sum, we continue to advocate to CMS that independent pharmacies cannot and should not pre-fund the MDPN Program, nor was it the intent of Congress that pharmacy do so. Without CMS making the necessary changes that we outline, including CMS pre-funding the program, pharmacies will not be able to afford to dispense these drugs and the MDPN Program will fail.
