On January 1, 2026, ten of the most widely used and expensive brand drugs in Medicare will be placed into their own acquisition and reimbursement system, known as the Medicare Drug Price Negotiation Program (MDPNP). Recently, CMS created guidance for this program, which will ultimately result in a system where a pharmacy’s reimbursement for these ten drugs is capped at the acquisition cost of the drug, resulting in a maximum gross profit of zero dollars or worse. This could drive pharmacies out of Medicare altogether and severely undercut
patients' ability to receive the medications they need.

CMS’s Faulty Guidance

A Pharmacy's Max Profit Will Be Zero: The Part D plans’ maximum reimbursement is the drug’s Maximum Fair Price; the drug maker’s maximum access payment is the WAC price minus the MFP; therefore, the pharmacy's maximum gross profit will be zero dollars or worse.
Slow Pay: The drug maker can make the access payment up to 44 days after claim adjudication; the average pharmacy will carry a new perpetual receivable of $27,000.

ASK YOUR CONGRESSPERSON TO GET CMS TO FIX THEIR GUIDANCE

Full Access Payment: Require the drug maker to set the access payment to equal WAC minus the total Part D plan reimbursement.
Upfront Access Payment: Require drug maker to make the access payment in the form of an upfront discount to the acquisition price so there is no delay; but if not, require the access payment to be made within 14 days of claim adjudication.
Real Dispensing Fee: Require the Part D plan to pay a dispensing fee that covers the professional cost of dispensing.