ASCP and NCPA Announce Joint Recommendations to Manufacturers to Effectuate Medicare's Maximum Fair Price (MFP)
The two organizations, both of which represent pharmacists committed to high-quality care for all patients including Medicare beneficiaries, expressed concerns about the impact of the MFP, which is part of the Medicare Drug Price Negotiation Program (MDPNP). This was included in the Inflation Reduction Act of 2022 and enables Medicare to directly negotiate the prices of certain single-source medications without generic or biosimilar competition. CMS selected 10 drugs for an initial round of negotiations in 2023. These included medications for diabetes, heart failure, and peripheral artery disease. These negotiated prices, the highest that a Medicare Part D beneficiary or plan sponsor will have to pay for targeted medications, are slated to go into effect on January 1, 2026.
While ASCP and NCPA fully support ensuring fair medication prices for Medicare beneficiaries, an analysis conducted for NCPA found that under MFP, pharmacies may face manufacturer refund payment delays of more than 21 days, beyond the 14-day Medicare prompt pay standard. At the same time, pharmacies could lose nearly $11,000 in weekly cash flow and $43,000 annually. Over 93% of independent pharmacies surveyed by NCPA state they may not be able to stock some medications targeted for price reductions because of cash flow and reimbursement below cost; and most LTC pharmacies anticipate closures, staff layoffs, service reductions, and medications shortages stemming from the MDPNP. Pharmacists at greatest risk for these negative impacts include sole proprietors in rural and urban areas, pharmacies that heavily rely on prescription revenue, and long-term care pharmacies.
To address these concerns, ASCP and NCPA made several key recommendations to manufacturers, including the following:
'Most independent pharmacies and long-term care pharmacies care for populations that are heavily dependent on Medicare. It's critical that they are compensated in a fair and timely manner. Otherwise, they will face massive cash-flow problems and not be able to provide prescription services to their Medicare patients. A recent NCPA survey found that 93 percent of independent pharmacists would consider opting out of the program unless those concerns are addressed. That would be a disaster for Medicare beneficiaries and the program itself,' said Doug Hoey, NCPA's CEO.
'The IRA presents unprecedented threats to long-term care pharmacy as well as new opportunities to build a constructive, transactional relationship between pharmacists and manufacturers,' said Chad Worz. 'In developing and presenting these recommendations, we are hoping to send a fair and equitable framework that rekindles the historical partnership between pharmaceutical manufacturers and pharmacies. This, first and foremost, benefits patients while also protecting the sustainability of pharmacies and innovators. We look forward to continuing our constructive conversations with impacted manufacturers.'
ASCP and NCPA urge manufacturers to incorporate these recommendations into their MFP effectuation plans by September 1, 2025, ensuring pharmacies remain viable and patients retain access to essential medications.
About ASCP: The American Society of Consultant Pharmacists (ASCP) is the only international professional society devoted to optimal medication management and improved health outcomes for all older persons. ASCP's members manage and improve drug therapy and improve the quality of life of geriatric patients and other individuals residing in a variety of environments, including nursing facilities, sub-acute care and assisted living facilities, psychiatric hospitals, hospice programs, and home and community-based care.
About NCPA: Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing over 18,900 pharmacies that employ more than 205,000 individuals nationwide. Community pharmacies are rooted in the communities where they are located and are among America's most accessible health care providers.
Contact Information
Melissa Blacketer
Senior Director of Communications
[email protected]
703-739.1311
SOURCE: ASCP
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