US Medicare MFP rollout and bipartisan PBM bill reshape drug pricing

The Medicare Maximum Fair Price (MFP) program, introduced under the Inflation Reduction Act, began processing claims in January 2026. Early implementation shows that many health systems, federally qualified health centers and pharmacies lack the operational capacity to manage post‑payment adjustments, over‑ and under‑payments, and dispute tracking required by the new pricing framework. Vendors such as RxParadigm have adapted platforms to support these workflows, but the shift to large‑scale price coordination places new administrative and financial burdens on providers.

At the same time, the House Committee on Oversight and Government Reform advanced bipartisan legislation targeting pharmacy benefit managers (PBMs). The Pharmacists Fight Back in Federal Employee Health Benefit Plans Act would require PBMs to fairly reimburse pharmacies, apply manufacturer rebates to lower costs for beneficiaries, and ban steering patients to affiliated pharmacies, with penalties for non‑compliance. Additional proposals seek to tighten congressional oversight of the District of Columbia’s taxing authority and restructure Inspector General oversight. These measures aim to increase transparency, protect patients, and curb predatory PBM practices.