NCPA Asks CMS for Expedited Payments and Other Corrections to MDPNP Following Survey of Independent Pharmacies That Finds Cash Flow Problems

ALEXANDRIA, Va. (Feb. 27, 2026) – With approximately two months having elapsed since the federal government began implementing the Medicare Drug Price Negotiation Program, the National Community Pharmacists Association conducted a survey of its members to understand any issues they have been experiencing and ask the Centers for Medicare & Medicaid Services for assistance in resolving them. Survey respondents operate independent community and long-term care pharmacies.

Among other things, the survey found that 67 percent of pharmacy owners say it is taking 22 days or more to receive refunds from the manufacturer, with 22 percent saying it is taking more than 28 days to receive refunds. As a result of these cash flow issues, 60 percent reported dipping into pharmacy savings to make ends meet and continue business operations. Seventy-eight percent are having problems reconciling claims, the survey says, and 28 percent say they do not have all the information they need to reconcile payments from the Medicare Transaction Facilitator to the original prescription drug claim.

In a letter to CMS Administrator Mehmet Oz, NCPA is asking for several corrections to the Maximum Fair Price program that will support its members’ financial planning abilities, including urging the agency to expedite payments to independent pharmacies, clarify how manufacturers are implementing their pharmacy cash flow mitigation plans, and provide greater detail regarding the Maximum Fair Price refund calculation when it differs from the Standard Default Refund Amount (SDRA). NCPA is also asking CMS to continue urging manufacturers to use the SDRA, which is a reliable and known refund amount, and that SDRA apply to all versions of a manufacturer’s drug for the purposes of the MFP refund.

“We have worked cooperatively with 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,” wrote Ronna Hauser, PharmD, NCPA’s senior vice president of policy and pharmacy affairs, who later added, “Pharmacies cannot continue to dispense these drugs with delayed payments unless the cash flow issues significantly improve for the IPAY 2026 drugs and better mitigation strategies are in place for the IPAY 2027 drugs.”

To view Hauser’s letter to CMS, which also includes a comprehensive report on the MDPNP survey results, click here.