MFP: Stepping Confidently Into a New System

The Medicare Drug Price Negotiation Program and its Maximum Fair Prices (MFP) are about to reshape how independent pharmacies manage inventory, cash flow, and reimbursement in 2026 and beyond. There’s some good news buried in the complexity—but you need to act now. Three of the first 11 negotiated drugs—Farxiga, Xarelto, and Stelara—will be reimbursed to pharmacies at wholesale acquisition cost (WAC), which is economically equivalent to AWP minus 16.7%. This is known as the Standard Default Refund Amount, or SDRA, and should give some hope that the overall margin will not be negative, as some pharmacy owners have been concerned about. We are hopeful that the remaining manufacturers will follow J&J and AstraZeneca in this commitment.  

Our Index data estimates that in an average pharmacy, around 10% or $435,000 of dispensing revenue will go through this new model. That means that there could be over $22,000 per month that is being reimbursed from manufacturers, in a new and delayed reconciliation cycle. To refresh on the program, the drugs, and what to do, you can read these posts from earlier this year (Part 1, Part 2, Part 3). 

While this is good news, there is still action that needs to be taken by each pharmacy, in order to continue caring for patients on these MFP medications.  

1. Run your MFP utilization report to get a quick understanding of your store’s dispensing of these drugs. Using the approach outlined in Part 3 linked above, you can move patients to med-sync and return excess inventory to free up cash flow for the upcoming delay. If you are an Rx30 Insights or RCS member, these reports have been prepared for you in your dashboard.
2. Sign up with a Medicare Transaction Facilitator Data Module (MTF-DM) before the new year so that your pharmacy will be set to receive these additional payments. More information is available HERE. CMS is hosting another monthly call for Pharmacies, you can register for that here. 
3. Start prepping your reconciliation process to ensure all amounts owed are being collected. This one may be as simple as reaching out to whoever does your reconciliation and learning about their process, so that you know what to look for or what’s needed from you. For more info on Outcomes Reconciliation services, you can read more here.  

Don’t Forget 

One thing remains, and it is an important step that we often neglect: Communicate with your prescribers and patients. They will be hearing about this program, and there may be knowledge gaps that their pharmacist needs to fill in. Let them know how you will be supporting these medications, so they can feel confident continuing to send patients your way. Let them know how the new financial flow actually works, so no one is surprised by the price at the register, or on a remittance. Make sure they understand that whatever the question is, you can be their resource to explain and ultimately find the path forward together.  

Final Thoughts 

This small change can be used to advocate for pharmacy. Every question you answer, or message you proactively deliver, shows the value of having a knowledgeable, accessible drug expert in every community. Resist the urge to give quick answers if it doesn’t fully educate and build on the relationship.    

At Outcomes, we believe in expertise and connection.  Our systems are designed to bring the whole picture together to enable your business and propel our profession.