Q&A: Why Community Pharmacies are Displeased with the MDPNP | NCPA 2025

According to Lisa Schwartz, PharmD, senior director of professional affairs at the National Community Pharmacists Association (NCPA), drugs dispensed under the Medicare Drug Price Negotiation Program (MDPNP) could take up to 21 days for pharmacies to receive reimbursement. Along with a list of other complexities attached to the program, dispensing any of the 10 drugs selected for 2026 can create major cashflow issues for community pharmacies.

“We share some of the frustration and concern over the program. Some of the details as to how it would actually work have been slow to come out,” Schwartz told Drug Topics. “We've been struggling to make sure we understand it well so that we can advocate for better processes on behalf of our members. A lot of the dissatisfaction happens around there needing to be 2 parts to the payment on the claim, basically.”

In part 2 of interview with Schwartz, she discussed the current developments regarding the MDPNP, providing insights from her NCPA 2025 Convention & Expo presentation titled “Medicare Drug Price Negotiation Program: What Pharmacists Need to Know.”

Learn from Schwartz’s unique positioning as an NCPA leader overseeing and advocating for thousands of community pharmacies across the US. Also, find out why pharmacies have been particularly vocal against this groundbreaking prescription medication statute.

READ MORE: Pharmacy Owners Say They Are Unable to Participate in MDPNP

Drug Topics: Many pharmacies have expressed displeasure with the program and, as recently as September, up to 86% of pharmacies are considering not stocking MDPNP drugs. Can you explain why these sentiments exist and what the feelings among community pharmacies are at this current moment, as we enter the last 2 months of 2025?

Lisa Schwartz: Yes, and we share some of the frustration and concern over the program. Some of the details as to how it would actually work have been slow to come out. We've been struggling to make sure we understand it well so that we can advocate for better processes on behalf of our members. But then, once the processes are finalized, [we want to] make sure that everybody knows how to best navigate that with their business for the coming year. A lot of the dissatisfaction happens around there needing to be 2 parts to the payment on the claim, basically. I think part of the dissatisfaction comes from this. It is a little bit complicated. We haven't understood it well until the last couple months.

Pharmacies are going to need to manage a pretty significant change to their cashflow. When one of the 10 drugs that has a maximum fair price (MFP) for 2026 gets dispensed, until the patient has met their deductible, there's still some copayment that happens at the pharmacy. That part stays the same. There's still reimbursement based on the Part D network contract that happens from the pharmacy benefit manager (PBM) within 14 days of a clean claim. That part stays the same. But some of the dissatisfaction comes [through] the patient's copay plus the reimbursement from the PBM. I think we can anticipate that that's going to be below acquisition because it's going to reflect the MFP. The MFP is a ceiling price that, if CMS has done a good job negotiating, we think is going to be under what they've acquired the drug for. To make up that difference, there's a refund that comes from the manufacturer. The whole goal here, of course, is to make sure that the patient’s cost-sharing benefits from the lower negotiated price—which is kind of how we backed into this really complicated system.

That manufacturer refund then comes in a 14-day timeline. But the start of that 14-day timeline is delayed a bit after the date of dispensing, or the date that the claim is processed. We don't think it's going to be more than about a week, ideally. That does then potentially put the pharmacy 21 days or so behind in getting that payment to have all of the revenues accounted for on the dispensing event. It’s going to require some more complex reconciliation to make sure that: Yes, I got the patient’s copay; I got the PBM’s reimbursement; and yes, I got the manufacturer’s MFP refund payment.

Drug Topics: Where do PBMs fall in line when it comes to community pharmacies and the expected reimbursement for MDPNP drugs?

Lisa Schwartz: They're still going to be setting up the networks, adjudicating claims, sending reimbursement based on the contract terms. Despite this being a program that's supposed to be between CMS and the manufacturers, pharmacies have a role, PBMs have been given a role as well, [in] the paid claim responses that pharmacies are getting for the times that the drug is dispensed. I also can mention coverage; [PBMs are] still going to be determining formulary. They're not required to have these in preferred cost-sharing on formulary. They’ll be in different tiers of the formulary, I guess, is the easy way to say that.

But when something is dispensed, then the paid claim response is going to tell the pharmacy an estimate of what the manufacturer refund is. So [there’s] a bit of a [PBM] role there. Kind of like the situation is now, if the PBM is doing something like, if payments are delayed for a reason that doesn't seem logical to the pharmacy—or the reimbursement calculation from the PBM isn't what the pharmacy expects and is actually like problematic and based off bad information—we still have the ability to appeal that with CMS. [We will] appeal with the PBM, first of all, but [when] they're not receptive to that, CMS needs to know.

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