Predictable Chaos Meets Unprecedented Change in 2026 | NCPA Executive Update | January 9, 2026

January 9, 2026

Predictable Chaos Meets Unprecedented Change in 2026

Dear Colleague,

Gym memberships spike. Black-eyed peas fly off shelves. Resolutions are made (and broken). And in the pharmacy? Pure pandemonium. It must be January.

Every new year brings predictable chaos in the pharmacy - new insurance plans, PBM policy shifts, and the usual round of brand drug price hikes. But this year adds two game-changers:

1. Medicare Drug Price Negotiation Program (MDPNP)
2. An unprecedented wave of brand drug WAC price reductions

Right out of the gate in 2026, NCPA heard from members about price discrepancies such as 2025 WAC prices showing up on 2026 invoices and outdated catalog pricing. We raised these concerns with wholesalers, and they've assured us fixes are in place. Still, check your invoices carefully, especially for brand drugs, to confirm the lower WAC is reflected.

Many of the drugs with big WAC drops - Eliquis, Jardiance, and Farxiga, as a few of the more popular examples - are tied to the MDPNP. One missing piece? Manufacturer refund timing. Pharmacies will eventually get reimbursed for the difference between Maximum Fair Price (MFP) and WAC, but when? One owner emailed me on Jan. 2 saying: "We're underwater by over $3,000 on just eight Part D scripts." How fast those refunds are made will be crucial. Cash flow matters.

NCPA hosted a webinar last month that goes over the process for the refund to be made. It's worth watching and hearing the questions that came up from other pharmacy owners. We are also actively listening (issues or problems with the MDPNP?) to NCPA members about their experience with the MDPNP so we can convey your collective voices to CMS and ask for needed changes.

January always brings "predictable unpredictability," and that's true this year more than ever. There is some hope for MDPNP reimbursements to be better than previous years for selected Part D drugs for many pharmacies (but not all). But this year especially requires paying close attention to your drug orders and reimbursements. Report invoice anomalies. Watch your cash flow.

Best,

B. Douglas Hoey, Pharmacist, MBA
NCPA CEO

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NCPA Executive Update delivers insights on legislative, regulatory, policy, and industry developments from NCPA CEO B. Douglas Hoey, Pharmacist, MBA, to NCPA members and pharmacy leaders. We welcome your comments at [email protected].

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