Nearly one in five independent pharmacists say they will not stock drugs included in the Medicare Drug Price Negotiation Program, and another 67 percent report they may also choose not to participate. These findings come from a recent survey conducted by the National Community Pharmacists Association (NCPA).
“Independent pharmacists want this program to work, and they want to participate,” said NCPA CEO B. Douglas Hoey. “But the program must be implemented in a way that makes business sense or independent pharmacies won’t be able to participate to help make the program successful.”
The NCPA detailed these results in a letter sent to Mehmet Oz, head of the Centers for Medicare & Medicaid Services (CMS). The survey showed that 86 percent of respondents are considering not stocking drugs covered by the Medicare Drug Price Negotiation Program (MDPNP) or have already decided against it.
Regarding enrollment in the Medicare Transaction Facilitator (MTF), 39 percent of surveyed pharmacists indicated their pharmacy or all their pharmacies were enrolled. Another 31 percent had not started enrollment, while 22 percent had begun but not completed the process. Smaller groups reported either starting but abandoning enrollment (4 percent), being unaware of MTF (4 percent), or not participating in any Medicare Part D network at all (0.2 percent).
When asked about declining Pharmacy Benefit Manager (PBM) contracts for 2026, 47 percent responded affirmatively, with most citing Express Scripts as the PBM from which they declined contracts.
A large majority—87 percent—said they have yet to finalize all their contract year 2026 Part D agreements and do not know which plans they will participate in.
In his letter, Hoey stated: “NCPA has met with CMS multiple times and submitted comments that we believe provide straightforward solutions to address our concerns and would encourage pharmacy participation in the program. For example, NCPA continues to recommend that CMS revise the program such that Part D plans and PBMs must: 1) pay pharmacies no less than the MFP plus a commensurate dispensing fee when providing MFP drugs; and 2) not assess direct and indirect remuneration (DIR) fees on MFP drugs.”
The NCPA has warned CMS for over a year that unless business-related issues are addressed, independent pharmacies may opt out of participating in the negotiation program. The group submitted comments last July warning that unresolved flaws could discourage participation by these pharmacies. If fewer independent pharmacies take part, millions of patients who might benefit from lower drug prices could lose access to local pharmacy services.
“Almost a third of all Medicare Part D patients get their medicines from independent pharmacies,” Hoey added. “If the program is a net liability for independent pharmacies, they won’t be able to participate. And if they can’t participate, the success of the whole program is in jeopardy. Our letter to CMS outlines common sense recommendations to help assure the success of the program and achieve the objectives of lowering drug costs and optimizing medication effectiveness.”
The NCPA survey was conducted between August 15 and September 2 among approximately 10,450 independent pharmacy owners and managers; there were 405 responses.
Founded in 1898, NCPA represents more than 18,900 community pharmacies employing over 205,000 people nationwide.
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