Welcome to the Pharmacy and Dispensing Entity (DE) Resources page for the Medicare Drug Price Negotiation Program. Pharmacies and other dispensing entities ("dispensing entities") can find the information on this page necessary to prepare for the January 1, 2026 implementation of the Medicare Drug Price Negotiation Program, the date the negotiated maximum fair prices (MFPs), for the first ten drugs selected for negotiation covered by Part D go into effect.
Medicare Transaction Facilitator
CMS anticipates enrolling pharmacies and other dispensing entities in the MTF DM beginning in June 2025 Among other functionalities, using the MTF will allow dispensing entities to:
During Enrollment and Prior to January 2026
- Self-identify as anticipating material cash flow issues as defined in section 40.4.2.2 of final guidance as applicable;
- Access helpful information on using the MTF and assign system roles;
- Experience a streamlined enrollment procedure if enrolling dispensing entity chooses to rely on up to date NCPDP data;
- Instruct the MTF DM where MFP refund payments and remittance advice should be sent, including to a linked third-party support entity (TPSE) as applicable;
- Review manufacturer MFP Effectuation Plans, including plans for dispensing entities self-identifying with cash flow issues (expected this Fall)
- Review and sign MTF Agreements with CMS and their MTF contractors that will be responsible for operating the MTF
During Implementation
- Receive MFP refund payments from Primary Manufacturers who have opted in to the MTF Payment Module;
- Receive remittance for payment made by paper check or Electronic Remittance Advice that uses the X12 835 standard adopted under the Health Insurance Portability and Accountability Act (HIPAA) for electronic payments;
- Submit complaints or disputes;
- View reports on the status of PDE data processing through the MTF DM user interface, in order to aid in financial planning.
On this resource page, CMS will continue to share key information that pharmacies and other dispensing entities will need to be ready for January 1, 2026, including processes, timelines, and assistance for enrolling in the MTF. Please sign up to receive e-mails about the Medicare Transaction Facilitator by clicking this link, entering your email address, and selecting “Medicare Transaction Facilitator” under the Center for Medicare.
Enrollment Timeline
Upcoming Events and Opportunities
As CMS announces upcoming opportunities to learn about the MTF, links to register will be provided here.
Human-Centered Design Activities
The Medicare Transaction Facilitator Human-Centered Design Team is interested in gathering dispensing entity feedback. To express interest in providing feedback about the MTF’s design and functionality, provide your information via this link, and we may follow up to gather more information.
Information Collection Requests
The ICR for the Medicare Transaction Facilitator for 2026 and 2027 under Sections 11001 and 11002 of the Inflation Reduction Act (IRA) is now available. This ICR previously underwent a 60-day public comment period, concluding on December 27, 2024; CMS has made revisions to this ICR based on public comments and has released the documents for a further 30-day public comment period. CMS invites public comments on the information the federal government will collect related to maximum fair price (MFP) effectuation and the Medicare Transaction Facilitator. Respondents to the forms included in this ICR may include manufacturers of drugs covered under Part D selected for negotiation under the Inflation Reduction Act for the initial price applicability years 2026 and 2027, and the dispensing entities that dispense the selected drugs to MFP-eligible individuals, as well as other interested parties. The ICR is open for public input for 30 days. The comment period will close on May 1, 2025; comments can be submitted at this comment submission.
Drafted MTF Agreements
The Draft Medicare Transaction Facilitator Agreements outline the responsibilities of each party that will be engaged in the MTF and will be necessary for enrollment in the MTF. Feedback on the draft Agreements was due to CMS by January 31, 2025 and CMS anticipates posting revised Agreements this Spring. The draft Agreements can be found here.
Draft MTF 835 Companion Guide
The Draft MTF 835 Companion Guide defines how dispensing entities and their third-party support entities will retrieve claim remittance advice from the MTF and provides technical and connectivity specifications for the 835 Health Care Claim: Payment/Advice transaction Version 005010. This Draft MTF 835 Companion Guide contains instructions for electronic communications as well as supplemental information for ingesting/creating transactions while ensuring compliance with the associated Accreditation Standards Committee X12N Technical Report Type 3 and the Council for Affordable Quality Healthcare – Committee on Operating Rules for Information Exchange (CAQH CORE) companion guide operating rules. CMS seeks comments on the Draft MTF 835 Companion Guide regarding transaction sets and values the MTF will be transmitting. Additional file exchange information will be included in a future release.
Manufacturers are responsible for making Electronic Remittance Advice (for payments issued via electronic funds transfer) or remittance (for payments issued via paper check) available to dispensing entities if a Manufacturer opts out of payment facilitation in the MTF. Manufacturers are responsible for ensuring that the electronic remittance advice created and transmitted to the dispensing entity uses the X12 835 standard adopted under the Health Insurance Portability and Accountability Act (HIPAA) as applicable.
Public comments on the Draft MTF 835 Companion Guide are due Friday, May 30th by 5 PM ET. Please submit comments directly to MFPMedicareTransactionFacilitator@cms.hhs.gov. CMS anticipates posting a Final MTF 835 Companion Guide in Summer 2025. The Draft MTF 835 Companion Guide is available here (PDF).
Key Resources
- The Pharmacy and Dispensing Entities Resources Fact Sheet and Frequently Asked Questions document details key information for pharmacies and other dispensing entities that will engage with the new MTF system, a core component of implementing the Medicare Drug Price Negotiation Program.
- For more information about the Medicare Drug Price Negotiation Program broadly, including the manufacturers of the drugs selected for negotiations, the timeline for the implementation, program guidance, Information Collection Requests, and other relevant program information is available here.
Contact Us
Have a question, input, or feedback? For questions about the MTF, email MFPMedicareTransactionFacilitator@cms.hhs.gov. For general questions about the Medicare Drug Price Negotiation Program, e-mail us at IRARebateandNegotiation@cms.hhs.gov. Please sign up to receive e-mails about the Medicare Transaction Facilitator by clicking this link , entering your email address, and selecting “Medicare Transaction Facilitator” under the Center for Medicare.