Medicare Price Negotiations Pose Unintended Challenges for Pharmacy | Asembia 2025
Through communication and reform, pharmacies will be able to make changes in order to continue to provide the best care to patients.
The Inflation Reduction Act (IRA) is one of the most significant health care legislations in decades, requiring unprecedented collaboration and strategic planning from pharmaceutical manufacturers, pharmacies, and payers. In August 2024, the prices for the first 10 medications under Medicare’s price negotiations were announced. The 10 drugs include sitagliptin (Januvia); multiple Novo Nordisk variations for the treatment of diabetes, including insulin aspart (Fiasp); dapagliflozin (Farxiga); etanercept (Enbrel); empagliflozin (Jardiance); ustekinumab (Stelara); rivaroxaban (Xarelto); apixaban (Eliquis); sacubitril/valsartan (Entresto); and ibrutinib (Imbruvica).1,2
Through communication and reform, pharmacies will be able to make changes in order to continue to provide the best care to patients. | Image Credit: Снежана Кудрявцева - stock.adobe.com
In a session at Asembia’s AXS25 Summit, Brian Corvino, lead partner at Deloitte Consulting, and Blasine Penkowski, former chief strategic customer officer at Johnson & Johnson, discussed the scope of the IRA and the pharmacist’s role moving forward.1
“In short, your job is to be able to do something operationally that has never been done before within a pharmacy,” Corvino said.1 “For those dispensing entities, there's a set of plumbing and a set of operations between the manufacturer and the end dispenser, [but] those pipes don't exist.”
He stated that being able to build the processes for data flow as well as financial flow is a huge feat. Penkowski added that there are a tremendous number of new processes that need to be considered, but the intent of the program was to increase access for patients and make medication more affordable.1
“Like any major program, there's unintended consequences,” she added.1 “Having gone through 2 other major programs, this one has some pretty big ones, and because of the unintended consequences, we're going to see some patients have restricted access and it not be affordable for the players in the marketplace.”
Penkowski said because of cash flow issues, pharmacies will be “underwater for a long time.” In a session at the American Associated Pharmacies Annual Conference, experts shared a similar sentiment. There will be reimbursement shifts, administrative requirements, and new pricing regulations that will ultimately place a burden on independent pharmacies. Pharmacists were not represented well when the price negotiations were considered, and because of that, there are many unintended consequences for them.1,3
A major issue of the price negotiations includes Centers for Medicare & Medicaid Services not regulating the Maximum Fair Price, which will leave pharmacies vulnerable since pharmacy benefit managers will not be required to reimburse fairly and payment can be delayed by 30 to 45 days. As a result, some pharmacies might not carry the medications due to the delay in reimbursement.1,3
“The number one most trusted health care provider in the industry is the pharmacist,” Penkowski said.1 “We're going to do damage to that relationship if the customer satisfaction isn't there . . . [Patients] really rely on the pharmacist for many, many things, and this could damage that trust.”
However, despite the unintended consequences, it is essential for everyone in the health care ecosystem to work together to solve the issues. Communication between all sectors is required, according to Penkowski. She stated that Congress is already working to resolve some of these issues, and everything will continue to change to eliminate the challenges.1
“It could change drastically, but we have to keep talking to make this work for the patients because we're all here, in essence, to make sure that patients get the medications they need, and we, too, will be patient some days,” Penkowski said.1
Read More of Our Coverage: Asembia Specialty Pharmacy Summit
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