Independent pharmacies reluctant to stock drugs under Medicare negotiation program, NCPA survey finds

A new national survey shows that more than 90 percent of independent pharmacists do not sell drugs for which the Medicare Part D program attempts to negotiate lower prices. If they don’t, the administration’s efforts to lower prescription drug prices are doomed to failure, the National Community Pharmacists Association said today.

“Lower prices won’t mean much to people who can’t find the drugs,” said Douglas Hoey, CEO of the NCPA. “Unfortunately, the new CMS guidance fails to ensure fair reimbursement to pharmacies that dispense medications. It also fails to guarantee timely reimbursement. Pharmacists are healthcare providers and pharmacies are also businesses that cannot afford to lose money on the prescriptions they dispense. If this issue is not addressed, the president’s entire program is under threat.”

The administration in August announced a list of 10 drugs for which the Medicare Part D program will seek to negotiate lower prices. They include medications for diabetes, blood clots, heart disease and other conditions. According to the survey, 51% of respondents said they would strongly consider not stockpiling medications due to possible undervalued reimbursements from pharmacy benefit managers. Another 40% of respondents say they are somewhat considering not stockpiling medications.

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Medicare’s drug price negotiation program starts in January 2026. NCPA estimates that pharmacies that dispense drugs under the program will have to spend $27,000 of their own money each month to store the drugs, then wait a month or more for manufacturer refunds to be issued. entire pharmacy. For many pharmacies, the resulting cash flow crisis will be too much to absorb in an already difficult payment environment. It is important to note that the CMS guidance did not guarantee that payments made to pharmacies by PBM intermediaries would cover the pharmacy’s costs of acquiring and dispensing the drug.

Serving Medicare Part D patients makes up about 35 percent of the average pharmacy’s business, but low reimbursements are forcing many independent pharmacists to reconsider participating in the program. In a February survey, 93% said they were considering dropping out of college this year. In this most recent survey, 73% say they have not yet finalized their contract for 2025 and do not know which plan they will participate in. This is troubling given that open registration begins October 15.

Modest reimbursements also limit patients’ access to other medications. Prescriptions for the popular and expensive GLP-1 medications for diabetes and weight loss often result in payments from the insurance company that are lower than what the pharmacy paid for the drug. According to the survey, 95% of pharmacists who dispense them say they lose money with these drugs. Fourteen percent no longer stock them at all and 59% plan not to distribute them, the NCPA said.

Pharmacists are responsible for helping patients get the medications they need and use them safely and effectively. But, like all businesses, they must be paid more than they cost to keep their doors open and serve their communities,” the NCPA said.

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At a July congressional hearing in which lawmakers from both parties questioned the CEOs of the three largest PBMs, the head of Express Scripts said his company was happy to negotiate with pharmacists for reimbursements more equitable. But according to the NCPA survey, 98 percent of pharmacists said they were unable to negotiate with Express Scripts before this hearing. Ninety-six percent say they have also been unsuccessful in negotiating with Express Scripts since the hearing.

“PBMs offer take-it-or-leave-it contracts. They don’t trade because of their dominant market share, which is one of the reasons the FTC is investigating their trading practices,” Hoey said. “Pharmacists who wish to keep their patients are often forced to issue prescriptions at a price lower than the acquisition cost of the drug. “That’s why there are now 10 percent fewer pharmacies for patients to choose from, and that’s why many are considering abandoning the Medicare Part D program altogether.”

Congress is considering two significant PBM reforms this year. There is bipartisan support, but time is running out.

“If Congress doesn’t get this done this year, many pharmacies will drop out of the Medicare Part D program and patients will be stuck,” Hoey said. “Many more will close their doors permanently, leading more consumers to live in pharmaceutical deserts.”

This NCPA survey was conducted from September 24 to October 24. 11. The questionnaire was sent to approximately 4,135 owners and managers of independent pharmacies, and approximately 465 of them responded.