Negotiated-Price Refund Check (Pharmacy)
The refund a pharmacy should get for a Medicare negotiated-price drug, and by when.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Drug selected for negotiation
- Eliquis / Eliquis Sprinkle
- Date of service
- 2026-09-01
- Quantity dispensed
- 60
- WAC per unit on the date of service
- 10.10 USD
- MFP per unit
- 4.145072 USD
- Refund already received
- Yes
Result: Standard default refund amount $357.30: (WAC $10.10 - MFP $4.145072) × 60 units (CMS final guidance, section 40.4.1).
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Drug selected for negotiation
- Date of service (YYYY-MM-DD)
- Quantity dispensed (units)
- WAC per unit on the date of service
- MFP per unit (the CMS file's NDC-9 unit price)
- Amount paid by the plan and patient
- Acquisition cost per unit
- Refund already received
- Date to check (YYYY-MM-DD; blank for today)
How this is calculated
Citation
CMS final guidance (IPAY 2027 and MFP effectuation 2026-2027), section 40.4.1: standard default refund amount = (WAC per unit - MFP per unit on the date of service) x quantity; CMS MTF fact sheet (April 2026): 7 days, 14 days, then up to 5 business days. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.