Pharmacy Owners Say They Are Unable to Participate in MDPNP
The Medicare Drug Price Negotiation Program is anticipated to cause multiple issues for pharmacy owners and their cashflow sustainability.
Nearly 1 in 5 pharmacy owners have expressed that they will not be participating in the Medicare Drug Price Negotiation Program (MDPNP) because of its potential to increase cashflow issues and decrease revenue. Up to 67% of owners are considering not stocking the drugs included under the negotiations, according to a National Community Pharmacists Association (NCPA) news release.1
“Independent pharmacists want this program to work, and they want to participate,” said NCPA CEO Douglas Hoey, RPh, MBA, according to the release. “But the program must be implemented in a way that makes business sense or independent pharmacies won’t be able to participate to help make the program successful.”
The data for pharmacies’ feelings toward the MDPNP come from an NCPA survey of 405 pharmacy owners and managers conducted between August 25 and September 2, 2025.2 They were asked about their feelings toward stocking MDPNP prescription drugs, decisions to stay in Medicare Part D, and other questions related to pharmacy sustainability and revenue.
According to the survey’s 405 responses, 19% of pharmacies will not be stocking MDPNP drugs when negotiations take effect at the start of 2026. | image credit: dizain / stock.adobe.com
READ MORE: Medicare Drug Price Negotiation Could Expose Pharmacies to Significant Financial Risk | AAP 2025
The MDPNP is directly linked with the Inflation Reduction Act (IRA), signed into law by former President Biden in 2022. Under the IRA, lawmakers established the MDPNP, which was intended for the US Department of Health and Human Services (HHS) to work alongside drug manufacturers to negotiate on the prices of medications offered through Medicare plans.3
While the law and the price negotiation program were designed to save patients money, its potential impact on community pharmacies has been of significant concern within the greater pharmacy community. And with provisions of the IRA and MDPNP gradually taking place over the past few years, NCPA, their community pharmacy members, and many other advocates have been denouncing the negotiation program for quite some time.
“Like many government programs, the intent is good, but the unintended consequences undermine the goal,” said Hoey, according to a separate release from January of this year.4 “That’s exactly the case here. Everyone wants to reduce drug costs for seniors and taxpayers. But, as our research shows, the program is structured in a way that will force many independent pharmacies out of the Medicare Part D program.”
This time around, NCPA conducted a survey to gain further insights on pharmacies and their feelings toward the program. With results showing significant hesitation among community pharmacy decision makers, NCPA sent its findings to the head of the Centers for Medicare & Medicaid Services (CMS) Mehmet Oz, MD, MBA, this week.
According to the survey’s 405 responses, 19% of pharmacies will not be stocking MDPNP drugs when negotiations take effect at the start of 2026.1,3 There was also a large portion of respondents (67%) that are currently considering the same approach.
To gain an even larger scope of how community pharmacies are faring throughout these negotiations, the survey also explored general financial questions and PBM-related concerns for these pharmacies.
In the past year, 35% of pharmacies said that their financial health has declined significantly, with just 12% saying that they experienced an improvement. For PBMs’ roles in community pharmacy financial health, 44% said that Express Scripts was causing them the most financial stress, followed by CVS Caremark (30%) and Humana (11%).
“NCPA has met with CMS multiple times and submitted comments that we believe provide straightforward solutions to address our concerns and would encourage pharmacy participation in the program,” read the NCPA’s letter to CMS, according to the release.1 “For example, NCPA continues to recommend that CMS revise the program such that Part D plans and PBMs must: 1) pay pharmacies no less than the [maximum fair price] (MFP) plus a commensurate dispensing fee when providing MFP drugs; and 2) not assess direct and indirect remuneration (DIR) fees on MFP drugs.”
However, these solutions have yet to come to fruition. In the meantime, community pharmacies and their advocate groups like NCPA are expressing their concerns of further decreased revenue and pharmacy sustainability stemming from the MDPNP.
“If the program is a net liability for independent pharmacies, they won’t be able to participate. And if they can’t participate, the success of the whole program is in jeopardy,” concluded Hoey.1 “Our letter to CMS outlines common sense recommendations to help assure the success of the program and achieve the objectives of lowering drug costs and optimizing medication effectiveness.”
READ MORE: Senators Reintroduce Bill to Improve Pharmacist Medicare Reimbursement
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References
1. NCPA to CMS: Pharmacists may bail on Medicare Drug Price Negotiation Program. NCPA. News Release. September 4, 2025. Accessed September 5, 2025. https://ncpa.org/newsroom/news-releases/2025/09/04/ncpa-cms-pharmacists-may-bail-medicare-drug-price-negotiation
2. Report for Medicare Drug Price Negotiation Program and financial health of pharmacy. NCPA. September 4, 2025. Accessed September 5, 2025. https://ncpa.org/sites/default/files/2025-09/Sept-2025-NCPAsurvey-MDPNPandFinancialHealth.pdf
3. Martin K. Medicare drug price negotiations: all you need to know. The Commonwealth Fund. May 15, 2025. Accessed September 5, 2025. https://www.commonwealthfund.org/publications/explainer/2025/may/medicare-drug-price-negotiations-all-you-need-know
4. New analysis finds the Medicare Drug Price Negotiation Program threatens financial stability of American pharmacies. January 30, 2025. NCPA. News Release. September 4, 2025. Accessed September 5, 2025. https://ncpa.org/newsroom/news-releases/2025/01/30/new-analysis-finds-medicare-drug-price-negotiation-program
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