The National Community Pharmacists Association (NCPA) has given a stark warning to the Centers for Medicare & Medicaid Services (CMS) regarding the Medicare Drug Price Negotiation program.
The NCPA said in a Jan. 27 bulletin that “more than 90% of independent pharmacies may decide, or have already decided not to stock drugs in the Medicare Drug Price Negotiation Program because they will cause massive financial losses and potentially put them out of business.”
In explaining the Medicare Drug Price Negotiation Program, CMS said, “Because of the prescription drug law, known as the Inflation Reduction Act, Medicare is able to negotiate directly with drug companies to improve access to some of the costliest single-source brand-name Medicare Part B and Part D drugs.”
The first 10 drugs chosen for the start of the negotiation program, effective in 2026, are Eliquis; Jardiance; Xarelto; Januvia; Farxiga; Entresto; Enbrel; Imbruvica; Stelara; and Fiasp (including Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, and NovoLog PenFill).
Independent pharmacies’ refusal to stock those prescriptions “will be [devastating] to the program,” said B. Douglas Hoey, CEO of NCPA. “Patients who need these prescriptions will be unable to get them, because their pharmacies cannot participate in the program. It’s great the government removed big insurance’s PBMs [pharmacy benefit managers] from the negotiations, and the result was lower prices for these prescription medications. That’s an important outcome for patients and taxpayers. But if almost no pharmacies can stock the drugs because they will sustain huge financial losses, the program will collapse before it even starts.”
Hoey added that independent pharmacies would have to wait each month for reimbursement from drug manufacturers. “That will cause a massive cashflow problem in an environment where thousands of pharmacies have already closed,” Hoey said.
A recent NCPA survey revealed that 96.5% of responding independent pharmacies said PBM and plan reimbursement for Medicare Part D “threatened the viability of their business.” And “40.8% of independent pharmacists said they were paid below what they pay to buy the drug, approximated by the National Average Drug Acquisition Cost (NADAC), on more than 40% of the prescriptions they filled for Medicare Part D patients.”
Nearly 30% of responding independent pharmacies reported paying below NADAC on half or more of the prescriptions they fill for Medicare Part D patients. It’s a significant enough problem that 30.3% of independent pharmacists said they’re thinking about closing their businesses in 2025.
To prevent more independent pharmacies from closing, NCPA suggested a list of changes, including CMS barring “PBMs from requiring pharmacies to participate in the program in order to serve Medicare Part D patients, and it must also give pharmacies the ability to cancel PBM contracts without cause.”
