US Senator James Lankford (R-OK) has led a group of senators in sending a letter to Health and Human Services Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz. The letter raises concerns about the implementation of the Medicare Drug Price Negotiation Program (MDPN), part of the Inflation Reduction Act, which is scheduled to set Maximum Fair Prices for ten Part D drugs beginning January 1, 2026.
Senators Thom Tillis (R-NC), Steve Daines (R-MT), Marsha Blackburn (R-TN), Roger Marshall, M.D. (R-KS), and Bill Cassidy, M.D. (R-LA) joined Lankford in signing the letter.
The senators note that while CMS staff have worked to support access to negotiated drug prices, there are growing reports of missed deadlines and lack of responsiveness from the agency. “For example, CMS failed to meet their target deadline of starting claims testing by July 2025, and many pharmaceutical manufacturers have not been receiving responses from the Agency to technical questions submitted to the CMS-designated inbox,” they wrote.
The letter also highlights issues with outreach efforts toward dispensers outside traditional chain pharmacies, such as independent pharmacies and providers who self-dispense Part D oncology medicines. According to the senators, it is unclear if CMS is taking extra steps to help these dispensers enroll in the new payment system.
“Further, many pharmacies still do not know their reimbursements from either the Part D plan sponsors and PBMs, nor their refunds from the manufacturers, further creating hesitancy to enroll in the program,” states the letter. While about half of all pharmacies are enrolled—largely due to large retail chains—a September 2025 survey found that only 39 percent of community pharmacies had actually enrolled.
The senators warn that a poorly functioning payment system or one that fails to include all drug dispensers could impact seniors’ ability to fill prescriptions at community or rural pharmacies. They cite survey data indicating nearly 20 percent of independent pharmacies have already decided not to stock at least one negotiated drug because of financial concerns; an additional 67 percent are considering similar actions.
Under this new system, pharmaceutical manufacturers may need direct contact with individual pharmacies—something not previously required—and changes set for early 2026 will require clear standards so that pharmacies are properly reimbursed even if usual channels do not suffice. The letter points out vulnerabilities among community and rural independent pharmacies, many of which have closed in recent years.
The senators suggest that instead of developing a new payment system from scratch—which has created complexity—CMS could have used its existing Part D Manufacturer Discount Program as a template.
They also raise specific concerns about long-term care pharmacies serving patients in Skilled Nursing Facilities (SNFs). “Reimbursement reductions to long-term care pharmacies will cause closures and hours and service area reductions, leaving already vulnerable patients in SNFs, especially those in rural areas, at serious risk of displacement,” according to the letter.
“We urge CMS to take proactive measures to ensure the sustainability of long-term care pharmacies in light of the pending IRA implementation… If CMS waits, it may be too late,” write the senators.
Finally, they call on CMS for greater transparency and responsiveness as it prepares for significant changes ahead: “We understand that implementing a new program takes a tremendous amount of work and appreciate CMS’ efforts to ensure that all industries impacted by this law are aware of and prepared for upcoming changes.”
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