Maximum Fair Pricing: Understanding the Impact on Pharmacy Economics

By Chris Fitzmaurice, Vice President, Pharmacy Strategy and Informatics

Maximum Fair Pricing (MFP) is now live, reshaping how pharmacies and health care providers navigate drug pricing and reimbursement. As part of the Inflation Reduction Act, MFP aims to lower costs for Medicare beneficiaries through direct price negotiations between Medicare and drug manufacturers. While the goal is affordability, the program introduces new operational and financial complexity across the pharmacy ecosystem.

What Is Maximum Fair Pricing?

MFP is a core provision of the Inflation Reduction Act designed to establish fair, lower prices for medications commonly used by Medicare recipients. Through direct negotiation, Medicare determines a capped reimbursement price — the MFP — for selected drugs.

“One of the biggest challenges has been the slow rollout of meaningful guidance from CMS and HRSA,” said Kara Schweigel, manager of compliance solutions at ScriptPro. “Organizations need time to update policies, evaluate pricing impacts, and make technology changes to stay compliant.”

Implementation Timeline

The MFP rollout follows a phased, multi-year schedule:

• January 2026: Prices for the first 10 selected drugs are now in effect (e.g., Eliquis, Jardiance, Xarelto, Januvia).
• 2027: 15 more drugs, including Ozempic, Wegovy, and Ibrance, are set to join the program.
• 2028 and beyond: Medicare will continue adding 20 additional drugs per year.
  
  

Industry Concerns

With MFP now active, several real-world challenges have emerged for key stakeholders across the health care ecosystem:

• Pharmaceutical manufacturers are closely watching the risk of duplicate discounts, in which both 340B and MFP pricing may apply to the same medication. This scenario can reduce incentives for participation and access. Some manufacturers are signaling plans to expand 340B restrictions or place limits on contract pharmacies to offset financial losses.

• Health care providers, particularly covered entities, are facing tighter 340B margins under MFP’s lower reimbursement ceilings. Many safety-net hospitals rely on 340B savings to support patient care, and reduced margins can strain budgets. For some high-cost specialty drugs, the financial benefits of 340B may diminish, impacting revenues for hospitals and clinics.
  
  

Broader Market Impact

MFP is not only changing drug pricing, it is also influencing the broader health care and pharmaceutical landscape. Contract pharmacies, already under pressure from expanding manufacturer restrictions, may see additional limitations as MFP affects pricing strategies. This has implications for rural and underserved communities, where contract pharmacies are often the most accessible point of care.

In response to these pressures, there was broad support among manufacturers for the 340B Rebate Model Pilot Program, which was ultimately struck down ahead of its January 2026 implementation date. A revised version of the model is begging to take shape, signaling a strong interest in increased transparency, reduction of duplicate discount risk, and modernization of how rebates are processed.

“We’ve seen pharmacies serve as the financial engine for successful health systems,” said Chris Fitzmaurice, vice president of pharmacy strategy and informatics at ScriptPro. “When outside policy changes threaten that economic foundation, our focus is helping pharmacies develop adaptive strategies that maintain their crucial role in health care delivery, especially for vulnerable communities.”

Moving Forward

With MFP now active, pharmacies and health care providers should adopt a proactive approach to financial and operational planning. As CMS and HRSA continue to release program details, organizations should focus on the following strategic areas.

1. Confirm MTF Enrollment: Verify your enrollment with the CMS Medicare Transaction Facilitator (MTF)¹ to support rebate processing.
2. Leverage Educational Resources: Use Beacon’s MFP tools, including the MFP Overview and Rebate Claims Processing webinars², to stay current on compliance and operational requirements. Establish clear processes for monitoring MFP payments and escalating delayed reimbursements.
3. Strengthen Cash Flow Oversight: Monitor Days Sales Outstanding (DSO) closely to stay ahead of cash flow gaps during reimbursement delays.
4. Evaluate Reconciliation Capabilities: Ensure your systems can accurately track both payer and manufacturer payments. MFP introduces a split‑payment structure that many legacy systems cannot manage effectively. Use MFP calculators^3,4 to model the financial impact and support informed decision making.
5. Identify New Revenue Streams: Explore non-dispensing revenue opportunities, like ScriptPro’s Hospital Rebate Program, to offset reduced margins from MFP.
   
   

MFP marks a meaningful shift in pharmacy economics. While designed to lower patient costs, it also introduces challenges that require strategic planning, operational agility, and investment in robust financial management practices. Pharmacies that act now will be best positioned to thrive in this changing landscape.

ScriptPro’s Financial Advantage platform is designed to help pharmacies maintain financial confidence under MFP. The system tracks eligible claims down to the penny, reconciles both payer and manufacturer payments, and offers detailed reporting to support audit readiness. With full visibility into MFP split‑bill payments and manufacturer obligations, Financial Advantage helps organizations quickly identify shortfalls and protect their financial position as the negotiated drug list continues to grow. To learn more, visit scriptpro.com or contact us at 800.606.7628.

References

1. “Welcome to the Medicare Transaction Facilitator,” Centers for Medicare & Medicaid Services.
2. “MFP On-Demand Webinar Series,” Beacon.
3. Nelson, Lisa and Rowell, Hannah, “Estimating the Impact of Maximum Fair Prices in 2026,” National Association of Community Health Centers.
4. IRA Calculator. 340B Health.