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ADVI Expert John Coster Shares Insights from ACCESS Forum 2025: Medicare Drug Pricing
ADVI Health’s senior director of federal agency engagement and co-lead of ADVI’s IRA center of excellence, John Coster, PhD, RPh, sat down to share his insights from the recent panel discussions coming out of this year’s ACCESS Forum 2025 in Austin, TX.
John discussed the changes that will be coming to Medicare Drug Price Negotiation on January 1, 2026, when Medicare beneficiaries will be able to pick up prescriptions for their Part D drugs, and also highlighted the Centers for Medicare and Medicaid Services’ Medicare transaction facilitator – a data system meant to streamline the exchange of payments and data between manufacturers and pharmacies that participate in the Medicare Drug Price Negotiation Program.
Hear more of John’s insights:
ADVI Health’s John Coster, PhD, RPh, sat down to share insight from his panel discussion after this year’s ACCESS Forum 2025 in Austin, TX.
Panelists
Senior Director, Federal Agency Engagement and Co-Lead of ADVI’s IRA Center of Excellence
John is senior director, Federal Agency Engagement, and co-lead of the firm’s IRA Center of Excellence, where he drives ADVI’s Medicare drug negotiation effectuation initiatives, including upcoming guidance and regulation, Medicare drug renegotiation, 340B reforms, and Medicaid pharmacy program issues.
Full Transcript
John Coster: Hi, this is John Coster, Senior Director with ADVI. It’s good to be here today to give you a little bit of insight as to what was discussed at a recent meeting in Austin for the U.S. Access Forum. It was a pharmaceutical pricing panel that discussed multiple topics such as tariffs, maximum fair price (MFP), and the status of the implementation of the Medicare drug negotiation program. That’s what I want to focus a little bit on today.
It’s really historic, and in less than 6 months, on January 1, 2026, Medicare beneficiaries will be able to pick up prescriptions for their Part D drugs, some of them at prices that were negotiated between the Federal Government and the manufacturers of those drugs. For the first 20 years of the Part D program, Medicare was prohibited from negotiating directly with manufacturers. That all changed with the Inflation Reduction Act (IRA) of 2022, and whether you like the act or not, almost everyone has to agree that it’s quite historic in terms of the way it will reshape the Medicare Part D program.
CMS, which is the agency responsible for administering the program, where I just spent the last ten and a half years, was responsible for determining how best to pass through those prices to beneficiaries. While the statute is really clear that it’s up to the manufacturers to make that happen, CMS implemented what’s known as a Medicare transaction facilitator. It’s a data system through which will flow data from Part D plans, from the plans to the manufacturers, and then financial information back into the pharmacies who are dispensing the Part D selected drugs at the maximum fair prices. The pharmacies are buying them at a higher price than the MFP, but only getting paid at the MFP, so there had to be some way to make the pharmacies whole.
This panel discussion, or part of the panel discussion, focused on the challenges that CMS and stakeholders are having in this groundbreaking new data exchange system. Anytime you create a new system like this, there’s going to be hiccups, especially in the short timeframe that we were given. But the stakeholders discussed some of the ways that the agency and the stakeholders themselves could make the process go more smoothly. That’s all in the interest of assuring that on January 1, beneficiaries can obtain their Part D prescriptions for these selected drugs at pharmacies at a reduced price.
There’s many issues in getting the MTF program up and running. That includes, for example, making sure all the pharmacies and other dispensers are enrolled, that assures making sure manufacturers get in their effectuation plans by September 1, that assures that pharmacies’ banking information is available so payments can be made; so multiple challenges ahead, At the end of the day, everyone’s interest is to make sure that beneficiaries get their prescriptions, and I think all stakeholders are working towards that end.
If you’d like to know more about this, please feel free to contact me or any one of my colleagues at ADVI Health, to give you the latest updates on what’s going on with implementation, which is now less than 6 months away.