NCPA had two meetings on Tuesday with CMS staff. In the first meeting, NCPA staff continued to advocate for its outstanding concerns with the Medicare Drug Price Negotiation (MDPN) Program. Among other things, we reiterated our concerns that pharmacies will have to float the program and shoulder an increasing burden; that pharmacies will not be paid fairly by PBMs; and that manufacturer refund payments to pharmacies will be delayed. In sum, we continued 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. We also emphasized that 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 program will fail.
In the second meeting, NCPA continued to advocate for fair contracting guardrails between PBMs/plans and pharmacies in Medicare Part D and discussed contract provisions that CMS has published in its Part D proposed rule. Members of NCPA’s Regional Chain Advisory Group also joined in the discussion. Among other things, NCPA discussed provisions in CMS’ Part D proposed rule that require plan sponsors/PBMs to include in their pharmacy contracts a requirement for pharmacies to be enrolled in the Inflation Reduction Act Medicare Drug Price Negotiation Program Medicare Transaction Facilitator Data Module, as well as urging CMS to amend its proposed language in the Part D rule to provide even greater flexibility for pharmacies to terminate a Part D contract or participation in a particular network without cause, given the market power of PBMs and their affiliated insurance companies and pharmacies. NCPA will share our concerns with CMS’ proposed rule in our comments by the Jan. 27, 2025 deadline.
