Independent pharmacists could be reluctant to sell the 10 Medicare Part D drugs on the federal government’s negotiated-price list — which could lead to reduced patient access to those medications.
In an Oct. 15 press release, the National Community Pharmacists Association (NCPA) said results of its new survey “shows more than 90 percent of independent pharmacists may not sell drugs for which the Medicare Part D program is trying to negotiate lower prices.”
“Lower prices won’t mean much to people who can’t find the drugs,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “Unfortunately, the new CMS [Centers for Medicare & Medicaid Services] guidance fails to ensure fair reimbursement for pharmacies that dispense the drugs. It also fails to ensure timely reimbursement.
“Pharmacists are health-care providers, and pharmacies are also businesses that can’t afford to lose money on prescriptions they dispense. The president’s entire program is in jeopardy if that isn’t addressed.”
The NCPA pointed out that the Biden-Harris administration released the list of drugs — including those that treat diabetes, blood clots, and heart disease — in August. CMS will be negotiating with drug manufacturers for lower Medicare prices for those medications.
Left out of the equation, however, is how pharmacy benefit managers (PBMs) will impact a pharmacy’s ultimate reimbursement for those drugs.
The survey’s results included 51% of participants saying they are “strongly considering” not stocking those medications “because of the potential underwater reimbursements from pharmacy benefit managers. Another 40% of respondents say they are somewhat considering not stocking the medications.”
“The Medicare Drug Price Negotiation Program starts in January of 2026,” the association said. “NCPA estimates pharmacies that dispense drugs in the program will have to tie up $27,000 of their own money every month to stock the drugs and then wait a month or more for manufacturer refunds to make the pharmacy whole.
“For many pharmacies, the resulting cash-flow crunch will be too much for them to absorb in an already difficult payment environment. Importantly, the CMS guidance offered no assurances that the payments to pharmacies from PBM middlemen would cover the pharmacy’s costs to acquire and dispense the medicine.”
This latest NCPA survey was conducted from Sept. 24 through Oct. 11, 2024; approximately 465 independent pharmacy owners and managers participated. A February NCPA survey showed that 93% of respondents were contemplating leaving the Medicare Part D program for 2025.
