Reimbursement
Maximum Fair Price, year one: the float problem gets bigger in 2027
Ten drugs changed how pharmacies get paid in 2026. Fifteen more arrive in January, including higher-cost specialty products.
On January 1, 2026, Medicare's negotiated "Maximum Fair Prices" (MFPs) took effect for the first 10 Part D drugs, including Eliquis, Jardiance and Januvia. Patients pay less for these drugs, but the pharmacy's payment now arrives in two pieces, and the second one comes later.
How the money moves
The pharmacy still buys these drugs at full wholesale cost. At the counter, the plan pays only the MFP plus a dispensing fee. The difference, called the standard default refund amount, comes back later from the manufacturer through CMS's Medicare Transaction Facilitator. Guidance sets that reimbursement window at about 22 days. ADVI Health reports survey data showing most pharmacies wait at least that long, and at least a quarter wait longer.
How big the gap is
Before launch, a Three Axis Advisors analysis prepared for NCPA projected a weekly cash flow shortfall of about $11,000 per pharmacy. That's a projection, not a measured result. Real exposure depends on each store's Medicare mix and how many of the selected drugs it fills.
What changes in January
Fifteen more drugs enter the program in 2027. Several are higher-cost specialty and oncology products, so each prescription ties up more cash while the pharmacy waits for the refund. A 2028 group adds Part B physician-administered drugs. A study in the Journal of Managed Care & Specialty Pharmacy estimates long-term care pharmacies could lose 85% of revenue on negotiated drugs in 2027, more than $3 billion in total.
What owners/operators can do now
- Know which of your top Medicare scripts are on the 2026 and 2027 lists, and estimate your weekly float.
- Reconcile refund receipts against claims every week, not every month.
- Talk to your wholesaler about payment terms before the 2027 drugs arrive.
Sources: CMS, Medicare Drug Price Negotiation Program, Selected Drugs and Negotiated Prices; Three Axis Advisors for NCPA, "Unpacking the Financial Impacts of Medicare Drug Price Negotiation" (Jan. 2025); Drug Topics, Oct. 26, 2026; Bhardwaj et al., JMCP 2026;32(4):498-506.