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The Medicare Part D program will change significantly in 2026. These changes will be seen in the net price you pay for the most popular and expensive Part D brand drugs and how much you get paid for these drugs. Be prepared for a cash flow impact and take steps before January in order to ensure you can receive all of the payments you are entitled to. We have prepared the basics of what you need to know about the Medicare Drug Price Negotiation Program.
The Medicare Drug Price Negotiation Program
- Starts January 1, 2026 for ten of the most popular brand drugs
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The first ten drugs in the program: Eliquis, Enbrel, Enresto, Farxiga, Imbruvic, Januvia, Jardance, NovoLog, Stelara and Xarelto
- 15-20 additional brand drugs will be added each year thereafter
- Drugs will be removed from the list once generic/biosimilar enters the market
The Maximum Fair Price (MFP)
- Each selected drug will be subject to a Maximum Fair Price (MFP)
- The MFP will dictate what you pay to acquire a drug and what you will be paid for dispensing a drug
- The most you will be reimbursed by a patient/Part D plan for dispensing a drug will be the MFP plus any dispensing fee (there is no minimum dispensing fee required to be paid)
- The drug maker will pay you a rebate (likely) equal to the drug’s WAC minus the MFP
- The drug maker has up to 44 days after the date of dispensing to pay the MFP rebate to you; because of this delay, the average pharmacy’s cash flow impact could be $11,000/week; be sure you have access to any needed credit
The Medicare Transaction Facilitator (MTF)
- CMS is creating a data depository called the Medicare Transaction Facilitator to track all claims and rebates for selected MFP drugs
- All Part D contracts for 2026 will require you to be enrolled in the MTF
- According to CMS, enrolling in the MTF does not obligate you to dispense the ten selected drugs to Part D patients; however, LTC pharmacies may not have this choice
Enrolling With the Medicare Transaction Facilitator
- Enrolling in the MTF is needed to receive drug maker MFP rebate payments
- Update your store’s NCPDP data at least two weeks prior to enrolling in the MTF
- When enrolling in the MTF, the person designated as the “Authorized Signatory Official” will have the highest level of permissions to make changes in your MTF account including the bank information for receiving MTF Rebates; make sure the correct person is designated and check it regularly.
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When you are ready, enroll at https://mtf.cms.gov
- Enrolling allows you notify CMS if you will suffer material cash flow issues, be sure to notify CMS if this applies to your pharmacy.
Additional CMS Resources
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