When the Medicare Drug Price Negotiation Program (MDPNP), created under the Inflation Reduction Act, was implemented, it introduced a new layer of complexity into an already complex reimbursement system. Inside independent pharmacies, that complexity is very real. To understand what it looks like in practice, we spoke with Loren Pierce, (Founder/CEO, Pierce Pharmacy Management) an independent pharmacy owner operating four locations.
Let’s talk
Reach out to IPC, our Member Performance and Pharmacy Services teams are here to help you work through any issues you might have with the Medicare Drug Price Negotiation Program. We can conduct a working session to review your numbers and leave you with an action plan you can execute the same day.
“It Now Takes Six Parties.“ Loren describes the shift this way: Prior to the MDPNP, filling a prescription essentially involved four parties: the prescriber, the patient, the PBM, and the pharmacy. Now there are effectively two additional participants; CMS and the drug manufacturer, along with the connection of two other platforms. That expansion changed workflow overnight.
Loren Pierce
Founder/CEO, Pierce Pharmacy Management
The patient’s experience looks the same, but behind the counter, it is not.
“We Didn’t Expect This Level of Financial Exposure.” Independent pharmacy has always adapted to change. “We didn’t expect it to be simple.” But the level of cash exposure surprised Loren. “Across our four pharmacies we currently have about $30,000 outstanding tied to negotiated drugs.” Payments are typically arriving three to four weeks after dispensing. “Pharmacies still must pay wholesalers promptly, so we are effectively carrying the cost of the medication until settlement occurs.” When several high-cost prescriptions are dispensed in close proximity, that exposure compounds quickly.
What Loren Is Doing About It. Rather than reacting in the moment, Loren adjusted operationally. “We now track each affected prescription internally and reconcile it against the Beacon and MTF systems.” That means building internal tracking processes and dedicating staff time to reconciliation, without increasing payroll. He also implemented a structural workflow change: “We now require these patients to be enrolled in medication synchronization. That allows us to better predict dispensing dates, manage inventory, and limit unexpected purchasing spikes tied to negotiated drugs.” That predictability matters, because under MDPNP, timing equals risk.
After Adjudication: Where the Work Begins
IPC is seeing similar experiences nationwide, as shared by Samantha Pomeroy, Director of Pharmacy Services and Specialty Programs. In her one-on-one professional consultations with pharmacy members, a few things stand out, Payment predictability has negatively shifted, platforms require regular review for data discrepancies, especially around 340B.
Samantha Pomeroy
Director of Pharmacy Services and Specialty Programs
Independent Pharmacy Cooperative
Historically, Medicare Part D payment timing was predictable. Today, manufacturer rebates are typically arriving in the 22–28-day range, sometimes longer. Pharmacies rely on consistent payment timing because we purchase medications before we are paid. The administrative burden also shifted. The biggest burden is not claim submission; it’s tracking, reconciling, and verifying payments after the claim.
Samantha Pomeroy
Director of Pharmacy Services and Specialty Programs
Independent Pharmacy Cooperative
Accuracy, timing, and oversight are now part of dispensing.
Samantha Pomeroy
Director of Pharmacy Services and Specialty Programs
Independent Pharmacy Cooperative
Action Steps: Operational Discipline
One of the most effective adjustments IPC is recommending is strengthening synchronization through the Just-in-Time Med Sync Guide developed by Kelli Stovall, VP of Pharmacy Services & Clinical Programs.
Under MDPNP, synchronization must be precise. Just-in-Time Med Sync helps pharmacies:
- Coordinate fills intentionally for the 10 negotiated drugs
- Implement 5–7 day precalls
- Adjust ordering windows
- Confirm pickup or delivery before labeling high-cost medications
- Train staff on PMS queue discipline
One critical safeguard: Do not label high-cost negotiated medications until pickup or delivery is confirmed.
Action Steps: Financial Strategy
Operational discipline is only half the equation. Nick Secrest, Vice President – Member Performance Group, reports measurable shifts in purchasing ratios.
Nick Secrest
Vice President, Member Performance Group
Independent Pharmacy Cooperative
That movement creates opportunity. Higher GCR can free owners to strategically purchase more generics from cost-efficient secondaries, including the IPC Warehouse, while maintaining rebate tiers.
But data discipline matters.
What to do with your numbers:
- Monitor February/March as your “clean” baseline. December–January stock behaviors distorted some ratios. Use February forward to gauge true GCR movement and margin dollars (not just %).
- Reoptimize your primary/secondary split. If your GCR rose without doing anything, consider shifting more into high value generics via secondary, without tripping compliance thresholds. (IPC can model this with you.)
- Stay light on at risk brands entering genericization. Farxiga is expected to move multisource; once it does, prices can drop fast; don’t be caught holding inventory.
Cash-flow pressure and margin opportunities can happen simultaneously. As Nick summarizes:
Nick Secrest
Vice President, Member Performance Group
Independent Pharmacy Cooperative
In this environment, operational discipline and purchasing strategy must work together.
Why IPC and Why Now
This environment requires alignment. IPC is a member-owned cooperative led by independent pharmacy owners who live this reality daily. All three of our departments, Pharmacy Services, Member Performance, and Government Relations are aligned around one goal: protecting the operational and financial sustainability of independent pharmacies.
Pharmacy Services helps members:
- Navigate MTF and Beacon enrollment
- Understand each platform’s purpose and payment flow
- Identify data discrepancies and report
- Establish reconciliation processes and weekly data validation checkpoints
- Implement Just-in-Time Med Sync
- Train teams on disciplined workflows that reduce cash-flow risk on high-cost medications
Download your MDPNP Readiness Checklist
Member Performance is modeling GCR movement, optimizing purchasing strategy, and protecting rebate tiers. Government Relations continues to monitor policy implementation and advocate for operational simplification.
Because under MDPNP, success isn’t just about reimbursement. It’s about coordination. Independent pharmacies are adapting. With the right discipline, data, and alignment, you can remain both stable and profitable in this new environment.
You’re Not Navigating This Alone
Changes in pricing and cash flow can feel complex. The IPC Member Performance team works directly with pharmacy owners to help make sense of the numbers and plan the next steps.
