2026 Health Care Outlook: Doug Hoey, NCPA

By Doug Hoey, CEO of the National Community Pharmacists Association

I make no bones about it:
The pharmacy payment model as we know it today is atrocious. Recent columns of mine for “Health Care Outlook” have reiterated the National Community Pharmacists Association’s goal of changing the pharmacy payment model from its current confusing, convoluted and covert state to instead align the interests of pharmacists, their patients and payers. Well, as the old saying goes, “Be careful what you ask for,” because this year there is movement afoot to significantly alter the pharmacy payment system, providing opportunities to help transform the current broken model — and questions around what
unintended consequences may arise as a result.

As I write this in December, we’re looking with bated breath toward January 1, 2026, when the first 10 Medicare Part D medications whose new prices, known as the Maximum Fair Price (MFP), will take effect as part of the Inflation Reduction Act’s Medicare Drug Price Negotiation Program (MDPNP). While this program will somewhat dodge the pharmacy benefit managers and some of their anticompetitive behavior, there’s much we don’t know. Will manufacturers refund pharmacies based on the medication’s wholesale acquisition cost, as the Centers for Medicare and Medicaid Services (CMS) has recommended? How quickly will pharmacies receive that refund? In these days of ultra-thin profit margins, cash flow has never been more important. 

An NCPA survey of independent pharmacy owners/managers found that, not surprisingly, if pharmacies are being paid less than their cost to acquire a medication, they will not be able to dispense or carry that medication. NCPA has stressed this fundamental business reality in our outreach to CMS to help it develop a program that will ensure beneficiary access rather than reduce it. Independents dispense nearly 40% of the MFP drugs.

The importance of MDPNP rolling out appropriately is made even more important because of the growing number of pharmacy closures. NCPA and the University of Southern California updated our Community Pharmacy Desert maps, which show that one in eight neighborhoods are in a pharmacy desert. The NCPA-USC Pharmacy Access Initiative added important interactive features to this mapping tool to allow users to home in on areas, including congressional districts, where deserts exist or are only one critical access pharmacy away from a desert springing up. 

Likewise, the direct-to-consumer — or “pharm-to-table” — trend could be used to get the manufacturer’s net price to patients without PBMs needlessly adding costs by intercepting the transaction and extracting their various fees for formulary coverage and placement. Executed well, DTC could be an opportunity for pharmacies, taxpayers and patients to save money and be reimbursed appropriately. However, if not executed well, it could sidestep around local pharmacists. Omitting the medication experts with the patient relationship could lead to a cascade of unintended health consequences, such as polypharmacy and other health care coordination concerns. As with the DTC programs being announced by drug manufacturers, NCPA is working to see and influence what TrumpRx will look like, advocating for the huge network of almost 19,000 independent pharmacies that could play a role. The president has been very clear about his disdain for voting ballots sent through the mail. I have to imagine he would think prescription medications are just as important and should also be handled with at least the same amount of care.

While we keep pushing for fair prescription payment in federal and state programs and in the courts, we’re also focused on shaping the marketplace to promote the recognition of the value of local pharmacy networks like CPESN. This accelerates the evolution of the pharmacist being paid for quality services provided and provides a complementary revenue stream to provide stability in the pharmacy payment model. Through CPESN, pharmacists practice at the top of our training. We and our pharmacy teams do the service, and — as a result — get paid appropriately by employers and health plans.

NCPA is the megaphone for independent pharmacy, amplifying what’s working, what’s not, and what unintended consequences have arisen for our members and for the patients they serve. We support the focus on cutting out the PBMs and returning to a more direct relationship between manufacturers and pharmacies, but pharmacy owners need long-term solutions to provide stability for their businesses and their communities. We need the predictability, security and transparency that would come from legislative intervention. Congress can begin the recovery process from previous unintended consequences by passing PBM reform. With that handled, NCPA looks forward to continuing to work with our members and industry partners to innovate and find ways to provide prescriptions in an economically sustainable model to patients safely, efficiently and without the PBM markups, at the lowest possible cost.

Doug Hoey is CEO of the National Community Pharmacists Association.