For pharmacies, the start of 2026 brings a significant new process change for 10 drugs through Medicare Part D. Introduced in the Inflation Reduction Act (IRA) that passed in August of 2022, Centers for Medicare and Medicaid Services (CMS) established the Medicare Drug Price Negotiation Program (MDPNP) to negotiate Maximum Fair Prices for certain high expenditure, single source drugs and biologics.
The program kicked off on January 1—and with it, a new set of confusing, required regulations that will prompt some new challenges for pharmacies.
In fact, Avalere released a study showing 34 percent of prescriptions (or 74 million prescriptions) slated for the MDPNP for 2026 or 2027 are currently filled at an independent or franchise pharmacy. The report also found that 30 percent of Medicare Part D beneficiaries (or 12 million beneficiaries) received at least one of these prescriptions at an independent or franchise pharmacy.
Doug Robichaux, Regional Operations Director at LTC Pharmacy Management, explains, “This presents a challenge for all pharmacies, not just long-term care pharmacies, that bill Medicare. For pharmacies, it's almost like we're fronting the government system here, and having to kind of float the Medicare program.”
Still grappling with the new rules? Need additional support? We're here to help.
With the passing of the IRA, the law allows Medicare to negotiate the price of certain drugs. This negotiated price, Maximum Fair Price (MFP), is now the maximum amount that Medicare Part D plans or beneficiaries can pay for a drug under the MDPNP. The first round of covered drugs under Medicare Part D went into effect on January 1, 2026.
The products in the first round for MFP effective January 1, 2026 are:
You can read more about how CMS orchestrated the negotiation process with drug companies here.
There are several ways independent pharmacies must adjust their business operations.
Summary of changes are:
Doug explains: “So for instance, Eliquis, one of the number 1 drugs in long-term care, its’ maximum fair price will be $231 for 2026, whereas that might cost us a little over $345 for a bottle of Eliquis. We're going to receive the $231 from the PBM first when we submit our claim, and then after that, we'll get a refund from the manufacturer somewhere between 21 and 28 days. The manufacturer, under regulation, has 14 days upon the presentation of a clean claim to get it paid.”
The MTF is the web-based platform that facilitates the MDPNP. It is responsible for supporting MFP operations between pharmacies and manufacturers.
The MTF serves as the recordkeeper for all entities involved in this process. It also:
All MFP refunds and 835 remittance files will be handled in MTF.
BeaconMFP is a web-based platform all pharma manufacturers are using to validate MTF refund payments for the 2026 MFP drugs.
Additional benefits to the MTF include:
This is a completely FREE tool available for pharmacies. Note: The Beacon tool is optional, MTF is mandatory.
How much will these price changes affect your specific pharmacy? One location over another?
Doug recommends data analysis beginning in early September when the new drugs are released for 2027 to see what the changes will really mean for your pharmacy:
"The data analysis is basically going to tell you your operating margin. So, you know what you're buying the drug for, how often you’re dispensing the drug, and what you're getting reimbursed from the PBM, and what you’re getting reimbursed from the manufacturer.”
We know, it’s hard. The industry stays busy as an important piece of healthcare that’s touched by a large handful of government agencies. Doug recommends utilizing resources like Senior Care Pharmacy Coalition (SCPC) for LTC pharmacies, and other organizations like the National Community Pharmacy Association (NCPA).
“I would also highly recommend any pharmacy that does a lot of Medicare billing to subscribe to CMS listserv. Listserv has a variety of email notifications that come in from the MTF, DM, and other sources on MFP, and it's a good way for pharmacists and business owners to keep in touch with what's going on at a regulatory level,” he says.
The complexity doesn’t end there. If you’re a 340B covered entity, the start of 2026 also marks the kickoff of the Health Resources & Services Administration (HRSA) 340B Rebate Pilot Program. * The goal of the program is for manufacturers to have better transparency and avoid duplicate discounts. The program allows:
Beacon offers another free solution, the Rebate Model, to effectuate the 340B Rebate Model Program. To receive rebates through this program, you must submit pharmacy claims data directly or via a Third-Party Administrator into the Beacon Rebate Model platform within 45 days.
*As of 01/09/2026, a federal judge has issued a temporary restraining order blocking this program to begin. The Trump administration has asked the First Circuit Court of Appeals to overturn the ruling. We will update this section as new information allows.
If you’re a part of the PioneerRx, BestRx or QS/1 family—we have training videos for you! Our team has made important updates in the software to ensure you’re capturing important MFP details.
PioneerRx:
BestRx:
NRx and PrimeCare:
This is just the beginning of additional changes made under the IRA through MDNP. It’s important to stay up to date on these new regulations to understand what changes you need to implement and how they will affect your business.
“Albeit it's a win for Americans to have less expensive drugs, we have to be mindful of the providers like us, especially in long-term care, because we're providing a 24-hour service, free delivery, and lots of specialty services we provide to people that really need it,” Doug says.
Questions? Reach out to us at blog@redsailtechnologies.com.
