Order (Not) Ready. The National Community Pharmacists Association surveyed just under 500 independent pharmacy owners and the results are really interesting. Almost ¾ had not signed 2025 Part D pharmacy contracts as of about a month ago. Of those that dispense GLP-1 agonists, 96% lose money on them; it makes sense why 59% are thinking about not dispensing them and 14% said they already stopped. The economics of dispensing branded drugs are not awesome for pharmacies.
Which ties back to the stat that is has been haunting me — 51% are strongly considering not stocking the Medicare negotiated Part D drugs in 2026 because pharmacies will have to wait to be reimbursed by manufacturers at the maximum fair price. Another 40% are considering it. My understanding is that pharmacies will be reimbursed within 14 days but profits, already tight, will be tighter. And honestly, perception is reality. If 51% said strongly considering it – that’s a problem for the Centers for Medicare & Medicaid Services (CMS). We pulled pharmacies into a process they didn’t need (not to mention explaining the Medicare Prescription Payment Plan). And patient access will likely suffer as a result.
Not Dead Yet. In late August, Johnson & Johnson announced they were moving to a refund model for 340B starting October 15. After pushback from Health Resource and Services Administration (HRSA), the agency that oversees the 340B program, J&J changed its plans. But it’s not likely over for the refund model. One of the challenges of 340B is a lack of data to confirm that there are no duplicate claims and ensure overall integrity. A refund would require data before payment. It isn’t saying no payment, just data please. If you want to understand all this a bit better, PhRMA’s letter to HRSA has a nice outline of the issues.
Measuring Success. I read this NEJM article on the 1st round of Medicare negotiation and I pictured the unfurling of a Mission Accomplished banner. I’m not saying that the “negotiations” went poorly but it just seems too soon to tell. Especially when paired with this Health Affairs post on evidence review as part of the negotiation process. CMS is new to this and does not have protocols. Or, if they do, they have not been made public. And digging through evidence and using it to arrive at a fair price takes time – which is hard when you have 20 drugs a year to eventually get to (and more once we get to renegotiations.) Not impossible, just tough. And an area to keep an eye on.