The National Community Pharmacists Association (NPCA) is warning the feds that independent pharmacists are likely to face significant financial hardship due to Medicare drug price negotiations.
In comments submitted on the latest Medicare advance notice, the organization says it conducted a survey of 8,000 pharmacy owners and managers about the drug price negotiation program and found that 93.2% have either decided not to stock drugs under negotiation or are considering not stocking these products.
The survey found that 32.8% of independent pharmacists have already made the decision to not stock one or more of the 10 drugs in the first round of negotiations. In addition, 60.4% of those surveyed said they are considering similar steps.
The NCPA said this is because they’re concerned about “financial losses” through the program.
“That will be devastating to the program,” said NCPA CEO B. Douglas Hoey in a press release. “Patients who need these prescriptions will be unable to get them, because their pharmacies cannot participate in the program.’
“It’s great the government removed big insurance’s PBMs from the negotiations and the result was lower prices for these prescription medications. That’s an important outcome for patients and taxpayers,” Hoey continued. “But if almost no pharmacies can stock the drugs because they will sustain huge financial losses, the program will collapse before it even starts.”
In its comments, the NCPA said it analyzed the finances of 5,200 community pharmacies and found that an average pharmacy would have to float $27,000 each month while waiting for manufacturers’ maximum fair price rebates to come in.
Beyond the price negotiation program specifically, independent pharmacies are frequently cash-strapped, the survey found, with 80.3% saying the health of their business worsened last year. Nearly half (48.6%) said their financial health significantly decreased in 2024, and 30.3% said they considered closing up shop in 2025.
The pharmacists pointed the figure at pharmacy benefit managers and reimbursement under Part D as a major factor, according to the survey. Most (96.5%) said PBM and Part D reimbursement “threatened the viability of their business.”
About 41% said they were paid less than what they paid, based on the National Average Drug Acquisition Cost, for more than 40% of prescriptions in Part D. Close to 30% said the same for more than 50% of Part D prescriptions, according to the survey.
In its comments, the NCPA said the feds should bar PBMs from requiring that independent pharmacies participate in the program in order to secure Part D reimbursement. The organization also argued that pharmacies should be able to “cancel PBM contracts without cause.”