NCPA Advocates for Medicare Drug Price Negotiation Program Overhaul Due to Pharmacy Cash Flow

DATE: March 6, 2026

By Brian Nowosielski | Drug Topics

With its initial rollout beginning in 2026, the Medicare Drug Price Negotiation Program has caused significant strain on the cash flow of independent pharmacies.

The National Community Pharmacists Association (NCPA) is sounding the alarm over the federal government’s implementation of the Medicare Drug Price Negotiation Program (MDPNP) after a recent survey of its members revealed significant financial distress, according to a news release.

“We have worked cooperatively with the Centers for Medicare and Medicaid Services (CMS) since 2022 on the implementation of the MDPNP and appreciate the interaction we have had with CMS senior leadership and program staff in this matter,” Ronna Hauser, PharmD, NCPA’s senior vice president of policy and pharmacy affairs, said in the news release. “Pharmacies cannot continue to dispense these drugs with delayed payments unless the cashflow issues significantly improve for the initial price applicability year (IPAY) 2026 drugs and better mitigation strategies are in place for the IPAY 2027 drugs.”

Approximately 2 months into the program’s official implementation, independent community and long-term care (LTC) pharmacies are reporting severe cash flow problems that threaten their ability to keep essential medications on the shelves.

The Cashflow Issue

According to the NCPA survey, which included more than 500 responses from pharmacy owners and managers, 67% of respondents reported it is taking 22 days or more to receive required refunds from drug manufacturers. For 22% of those surveyed, the turnaround time for these refunds has stretched beyond 28 days.

These delays are particularly damaging because pharmacies are often required to pay their wholesalers within 14 days of purchase. This “buy high, sell low” model forces pharmacies to float the difference between their high acquisition costs and the lower negotiated prices while waiting weeks for a rebate.

The financial toll has forced 60% of surveyed pharmacy owners to dip into their personal or business savings to sustain operations.

Beyond immediate cash flow, the survey highlights a growing administrative burden, with 78% of owners reporting problems reconciling claims. Furthermore, 28% of respondents noted they lack the necessary information to reconcile payments from the Medicare Transaction Facilitator with their original prescription drug claims.

The NCPA and Senior Care Pharmacy Coalition’s Responses

In response to these findings, Hauser sent a formal letter to CMS Administrator Mehmet Oz, MD. The NCPA is urging CMS to expedite payments to independent pharmacies and clarify how manufacturers are implementing their cash flow mitigation plans. The NCPA is also asking the agency to require manufacturers to use the standard default refund amount, or SDRA, a known and reliable figure that would assist pharmacies in financial planning.

The crisis is not limited to retail community pharmacies, as the Senior Care Pharmacy Coalition (SCPC) warns that LTC facilities are under similar pressure. SCPC Executive Director Alan Rosenbloom noted that without legislative fixes, such as the Preserving Patient Access to Long-Term Care Pharmacies Act, 60% of LTC pharmacies may be forced to close in 2026.

The SCPC highlights that LTC pharmacies face dispensing costs between $15 and $17 per prescription, yet they are currently receiving little to no margin on these negotiated drugs to cover those costs.

Experts have described pharmacies as the canary in the coal mine for the broader success of the Inflation Reduction Act’s drug-pricing provisions. Although CMS estimates the program could save the government billions, the practical implementation has left pharmacists in every corner of the health sector fearing for business viability.

If pharmacies refuse to stock negotiated drugs — a step 64% of NCPA survey respondents are currently considering — older adults, particularly in rural areas and pharmacy deserts, may lose access to life-saving treatments.

As the program moves toward its second year, the NCPA maintains that pharmacies cannot continue to dispense these medications unless mitigation strategies significantly improve. The association stresses that although they support lower drug prices for patients, the current system places the entire cost of implementation on the backs of small-business pharmacies.

Industry leaders now look to CMS to establish more robust monitoring of Part D plans and manufacturer compliance to prevent a total collapse of the pharmaceutical supply chain.

“This type of financial stress on small businesses that operate on very slim margins is unsustainable,” concluded Hauser in her organization’s letter to CMS. “Unless addressed, this situation will only be further exacerbated as an additional 15 high-volume, high-cost Part D drugs with MFPs come online in January 2027.”

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