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Medicare’s Fair Price Is Coming: What Independent Pharmacies Need to Do Now

Independent pharmacist reviewing inventory on a tablet while organizing medications on pharmacy shelves.

The Inflation Reduction Act is about to reshape how money flows through your pharmacy. Starting January 1, 2026, Medicare will begin paying Medicare Fair Prices (MFPs) for a select group of high-cost drugs.

For patients, this means lower copays.
For independent pharmacies, it means tighter cash flow, with delayed refunds adding another layer of complexity to already thin margins.

The First Ten Drugs Under MFP

The opening round of negotiated drugs includes:

  • Eliquis
  • Jardiance
  • Xarelto
  • Januvia
  • Fiasp/NovoLog
  • Farxiga
  • Entresto
  • Enbrel
  • Imbruvica
  • Stelara

If your pharmacy dispenses Eliquis or Jardiance every day, you’ll feel the impact immediately. If you rarely fill specialty drugs like Imbruvica, the effect may be minimal. The bottom line: the financial hit won’t be uniform—but if you’re affected, the lag in payment will hit your bottom line fast.

What Pharmacies Should Do Now

The difference between scrambling in January and being ready comes down to preparation. Here are three steps to take today:

1. Prepare for MTF Refunds

CMS is auto-enrolling pharmacies into the Medicare Transaction Facilitator – Data Module (MTF-DM) using NCPDP profiles. You’ll be asked later to verify your identity and payment information.

Action: Double-check your NCPDP profile now—ownership, address, and banking details must be current to avoid delayed or lost refunds.

2. Track the “AMC 061” Flag

This claim marker indicates an MFP refund. You’ll find AMC 061 in field 548-6F on your paid claim response.

Action: Confirm that your pharmacy management system can capture or export claims flagged with AMC 061. This will be essential for matching payments later.

3. Run a Claims Report and Assess Exposure

Pull your claims for the 10 MFP drugs and review:

  • Weekly or monthly fill volume
  • Current reimbursement compared to WAC
  • The projected gap once MFP pricing takes effect

The Cash-Flow Reality

Here’s how the payment timeline plays out:

  1. You dispense the drug.
  2. The plan pays you based on MFP, often below WAC.
  3. CMS routes the claim to the MTF.
  4. Manufacturers have 14 days to send the refund.
  5. You receive the refund, often 3+ weeks after dispensing.

Add weekends, bank delays, or mismatched data—and cash can be tied up even longer. If you’re filling 40 Eliquis scripts a week, that’s thousands of dollars stuck in limbo.

NCPA continues to push for faster refunds and fewer fees, but for now, this is the system.

The Bigger Picture

Compliance is only step one. Long-term strategy is where independent pharmacies can stay ahead.

  • Map your exposure to the first 10 drugs.
  • Build cushion in areas you control: generics, OTC, private pay.
  • Secure rebate and tier protection before MFP influences commercial contracts.

How PharmaTrust Supports Pharmacies

At PharmaTrust, we’re already preparing members for the MFP shift with safeguards to protect cash flow and simplify operations:

  • Streamlined rebates with no moving targets
  • Tier-protected pricing across brands, GLP-1s, and specialty
  • Daily performance dashboards for visibility
  • Hands-on support with payment reconciliation
  • The Inflation Reduction Act is bringing Medicare Fair Prices, whether you’re ready or not. Independent pharmacies that prepare now will weather the change—and protect their profitability.

 Talk to PharmaTrust today to make sure your store stays ahead of the curve.