NCPA: Biden’s Drug Program Will Fail if Pharmacies Are Paid Too Little and Too Late

Key Takeaways

NCPA warns that CMS's guidance on Medicare drug price negotiations may harm patient access and pharmacy operations.
CMS's lack of requirements for fair reimbursement and timely payments could financially strain pharmacies, risking closures.
An NCPA poll shows 92% of pharmacies may not stock negotiated drugs, threatening patient access and program success.
NCPA urges the White House and CMS to revise their approach to prevent negative impacts on pharmacies and patient care.

CMS’ failure to require timely, sufficient pharmacy reimbursement will lead to closures not seen since the start of Part D and patients will suffer as a result.

The National Community Pharmacists Association today warned that President Biden’s plan to negotiate drug prices in Medicare will fail and patient access to the first 10 negotiated drugs will be jeopardized beginning in 2026 because the Centers for Medicare & Medicaid Services neglected in its final guidance to prevent pharmacy benefit managers and manufacturers from paying pharmacies too little and too late.

In comments to CMS on the draft guidance, NCPA stressed the need for the agency to ensure that PBMs reimburse community and long-term care pharmacies fairly for maximum fair price (MFP) drugs — at a negotiated price that is no lower than the maximum fair price plus a commensurate professional dispensing fee. NCPA also emphasized that manufacturers must refund pharmacies within 14 days of adjudicating the claim. Otherwise, according to an NCPA analysis, the average pharmacy will have to float over $27,000 every month waiting to be made whole from the manufacturer refunds. Collectively among community and LTC pharmacies, the cash flow effect would be around half a billion dollars every month for just the first year of the program.

An informal NCPA poll of community/LTC pharmacy owners and managers in October 2024 finds that 92 percent of them are considering not stocking MFP drugs as a result.

The final guidance makes clear that CMS isn’t heeding these warnings, however: “CMS is not establishing requirements for dispensing fees for selected drugs at this time but will monitor complaints and audits related to this issue. CMS encourages plan sponsors to work with pharmacies to ensure adequate and fair compensation for dispensing selected drugs.” The CMS final guidance also says that pharmacies will not get paid within 14 days of dispensing the prescription, and NCPA anticipates it could take 30 days or longer.

“We had hopes that this program would bring benefit to the patients that we serve,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “Instead, with how CMS is proposing to run it, it appears pharmacy will be collateral damage — left holding the bag again, just as we were with the launch of Part D. More than 1,100 community pharmacies closed at that time. With the industry in such turmoil today, CMS’ head-in-the-sand approach to how PBMs will reimburse pharmacies for MFP drugs and how slowly manufacturers will refund them will lead pharmacies to close, limit patient access to MFP drugs, and set the program up for colossal failure. We implore the White House and CMS to change course.”