90% of independent pharmacies may not stock drugs in negotiation program: Study
A new survey by the National Community Pharmacists Association found that more than 90% of independent pharmacists may refuse to sell drugs targeted by Medicare Part D negotiations, potentially jeopardizing the Biden administration’s efforts to lower prescription costs.
The survey, conducted from Sept. 24 to Oct. 11, found that 51% of pharmacists are strongly considering not stocking drugs due to inadequate reimbursements from pharmacy benefit managers, with another 40% considering the same, according to an Oct. 14 NCPA news release shared with Becker’s.
The Medicare Drug Price Negotiation Program is set to begin in January 2026, but many pharmacies could face drug flow issues, needing to cover $27,000 monthly to stock the medications without guaranteed timely reimbursement.
As low reimbursements can affect the viability of independent pharmacies, 73% of pharmacists have not finalized their contracts for 2025, raising concerns as open enrollment begins Oct. 15.
Filed under: General Problems
This makes sense. My mom & pop pharmacy struggled to keep my adhd med in stock during the then and ongoing shortage, THANK YOU DEA. Not only was I paying more than my $5 copay, it got up close to $200 for one month. Now the pharmacist is giving me grief about asking for a printout of what I spent on that one med for the year 2024. Something isn’t right with this picture. The pharmacist even told me to go somewhere else!
Most contracts between PBMs & pharmacies have clauses in them that they cannot charge the pt “cash”, they are obligate by that contract that they MUST fill the Rx and bill it to the PBM and charge the pt what the PBM states what the pt’s copay is. In Theory, the PBM may cancel the pharmacy’s contract, they put the pharmacy is a no-win situation… bill the PBM for the med and get reimbursed for upwards of $200 less than the cost of buying the med from their wholesaler or charge the pt CASH for the Rx and be at risk of having their contract cancel their contract and the pharmacy ends up losing all the pt that are controlled by that PBM. Just remember, while it is claimed that there are 60 different PBMs, the top 4-5 PBMs controls 80% – 90% of all Rxs that are billed to a PBM. I have read where Caremark & Express Scripts manage >50% of the Rx paid for by a PBM.