This week, I’m rerunning some popular posts while we prepare for Friday’s live video webinar: PBM Industry Update 2026: Trends, Challenges, and What’s Ahead.

Since this article was published last December, Net Pricing Drug Channel developments have accelerated. Manufacturers reduced the list prices for 6 of the 10 products with an MFP for 2026. They have also preemptively reduced list prices for three products that will have MFPs in 2027 and 2028. For more on these trends, see Section 12.1.1. of our new 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Click here to see the original post from December 2025.
Contrary to popular belief, the Inflation Reduction Act’s (IRA) maximum fair prices (MFPs) could temporarily boost profits for retail pharmacies serving Medicare Part D patients.

The bad news? The IRA is also one of the five key forces deflating the gross-to-net bubble.

That’s why any IRA-related pharmacy profits will vanish if manufacturers lower list prices to be closer to net prices. At least 13 brand-name drugs—five of which have MFPs—reportedly plan to reduce list prices within the next two months.

As I show below, retail pharmacies risk becoming collateral damage from significant deflation in the gross-to-net bubble for drugs subject to an MFP. Welcome to our bonkers healthcare system—where everyone wants lower prices, until they actually get them.

What’s more, list price cuts will reduce profits from 340B contract pharmacy operations, while weakening covered entities’ main objections to a 340B rebate model. Get ready for a 340B slowdown.
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