NCPA: Independent Pharmacies Facing Cash Flow Gaps Under Medicare Drug Price Negotiation Program

In an interview with Pharmacy Times, Ronna Hauser, PharmD, senior vice president of policy and pharmacy affairs at the National Community Pharmacists Association (NCPA), discussed alarming survey findings revealing the financial strain that delayed manufacturer refunds under the Medicare Drug Price Negotiation Program are placing on independent pharmacies nationwide.

According to the NCPA survey of over 500 independent pharmacy owners, 67% are waiting more than 22 days for manufacturer refunds—well beyond the standard 14-day prompt-pay turnaround for Medicare Part D electronic claims—and 22% are waiting longer than 28 days. Hauser explained that NCPA had anticipated this cash flow challenge from the program’s early planning stages, noting that 21 days was likely the best-case scenario given the system’s structure. However, the real-world impact has proved significant: Pharmacies must purchase and pay for inventory on roughly 2-week wholesaler payment cycles, meaning many are effectively floating program costs out of pocket while awaiting reimbursement.

The financial consequences are tangible. Findings from a prior NCPA study estimated the average cash flow burden at approximately $11,000 per pharmacy. The new survey findings reflect this strain directly: 70% of pharmacy owners are limiting their inventory of high-dollar drugs, and 60% have had to dip into personal or business savings to maintain operations, a particularly acute burden for pharmacies already operating on razor-thin margins.

On a positive note, Hauser highlighted that branded manufacturers are refunding at the standard default amount—wholesale acquisition cost minus the maximum fair price—which has helped prevent pharmacies from going underwater on claims. NCPA is now actively working with the Centers for Medicare & Medicaid Services (CMS) and program partners to identify opportunities to accelerate payments at multiple points in the system, including faster plan data submissions, quicker manufacturer disbursements, and more efficient payment routing to member banks.