Alexandria, VA—Most independent community pharmacists say in a survey that they are considering not stocking drugs for which the Medicare Part D program is trying to negotiate lower prices.

That was the answer given by more than 90% of 465 independent pharmacy owners and managers responding to a National Community Pharmacists Association (NCPA) survey conducted September 24, 2024, to October 11, 2024.

The issue, according to NCPA leadership, comes down to timely reimbursement.

“Lower prices won’t mean much to people who can’t find the drugs,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “Unfortunately, the new CMS guidance fails to ensure fair reimbursement for pharmacies that dispense the drugs. It also fails to ensure timely reimbursement. Pharmacists are healthcare providers and pharmacies are also businesses that can’t afford to lose money on prescriptions they dispense. The president’s entire program is in jeopardy if that isn’t addressed.”

In August, the Biden administration announced a list of 10 drugs for which the Medicare Part D program will seek to negotiate lower prices. Those include common drugs for diabetes, blood clots, heart disease, and other conditions.

The survey found that 51% of respondents are strongly considering not stocking the drugs because of the potential underwater reimbursements from pharmacy benefit managers (PBMs), while another 40% of respondents say they are somewhat considering not stocking the medications.

When the Medicare Drug Price Negotiation Program starts in January of 2026, the NCPA estimates pharmacies that dispense drugs in the program will have to tie up $27,000 of their own money every month to stock the drugs and then wait a month or more for manufacturer refunds for reimbursement.

The Centers for Medicare & Medicaid Services has offered no assurances that the payments to pharmacies from PBMs would cover the pharmacy’s costs to acquire and dispense the medicine, NCPA said in a press release.

Medicare Part D patients make up about 35% of the average pharmacy’s business. An earlier NCPA survey found that 93% of independent pharmacies are considering dropping out of the program because of low reimbursements.

Last summer, Dr. Hoey told a congressional committee, “The PBMs offer take-it-or-leave contracts. They don’t negotiate because of their dominant market share, which is one reason why the FTC is investigating their business practices.” Dr. Hoey added, “Pharmacists who want to keep their patients are often forced to dispense prescriptions for less than their cost to acquire the medicine. That’s why there are now 10 percent fewer pharmacies for patients to choose from, and it’s why many are considering dropping out of the Medicare Part D program altogether.”

According to the Department of Health & Human Services, the new negotiated prices for 2026 include the following medications:

• Januvia from Merck Sharp Dohme, used for diabetes, was negotiated to $113.00 for a 30-day supply compared with a $527.00 list price
• Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, NovoLog PenFill from Novo Nordisk Inc., also used for diabetes, has a negotiated price of $119.00 for a 30-day supply compared with a $495.00 list price
• Farxiga from AstraZeneca AB, used for diabetes, heart failure, and chronic kidney disease, has a negotiated price of $178 compared with a list price of $556 for a 30-day supply
• Enbrel from Immunex Corporation, used for rheumatoid arthritis, psoriasis, and psoriatic arthritis, was negotiated to $2,355.00 for a treatment compared with a $7,106.00 list price
• Jardiance from Boehringer Ingelheim, prescribed for diabetes, heart failure, and chronic kidney disease, was negotiated to $197.00 for a 30-day supply compared with a $573.00 list price
• Stelara from Janssen Biotech, Inc., which is for psoriasis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis, was negotiated to $4,695.00 for a treatment compared with $13,836.00 list price
• Xarelto from Janssen, which is used for the prevention and treatment of blood clots, as well as the reduction of risk for patients with coronary or peripheral artery disease, has a $197.00 negotiated price compared with a $517.00 list price
• Eliquis from Bristol Myers Squibb, which is prescribed for the prevention and treatment of blood clots, was negotiated to $231.00 from a $521.00 list price
• Entresto from Novartis, which is used for heart failure treatment, has a negotiated price of $295.00 compared with a $628.00 list price
• Imbruvica from Pharmacyclics LLC, which is used to treat blood cancer, was negotiated from $14,934.00 to $9,319.00 for a treatment.

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