The ripple effects of Medicare’s maximum fair price with Hiva Pourarsalan, Pharm.D. | AMCP Nexus 2026

Medicare's maximum fair prices (MFPs) are lowering prices for drugs selected for negotiation, but they are also changing how rebates and contracts work, and those changes won't stay inside Medicare, according to Hiva Pourarsalan, Pharm.D., director of pharmacy at Aetna.

Pourarsalan co-presented “Beyond Price Negotiation: Has Maximum Fair Price (MFP) Reshaped Formulary Dynamics?” at AMCP Nexus 2026. The session looked at how prices negotiated under the Inflation Reduction Act, the first of which took effect in January, are shaping payer decisions, formulary placement and coverage policies.

Effects beyond Medicare

In this interview with Managed Healthcare Executive, Pourarsalan said Medicare plans are covering the selected drugs, as required, but the shift in rebates and contracting is likely to reach other lines of business, too.

“Not only does it affect the Medicare line of business, it also bleeds into commercial and maybe for some Medicaid,” she said, adding that payers need to recognize that MFP is not only a Medicare issue.

Lower prices don't guarantee savings

Pourarsalan has managed a Dual Eligible Special Needs Plan (D-SNP) for the past five years. She said the core challenge is the same for every type of Medicare plan, whether a D-SNP, a Medicare Advantage plan or a stand-alone Part D plan: Plans have to look at their overall costs. Wholesale acquisition costs are lower for selected drugs, but smaller rebates mean that doesn't necessarily translate into savings.

“I think the plans have to be more creative with ensuring that we cover these drugs, but also being creative with what else can we do to provide a more holistic, full formulary while still keeping the costs down," she said.

Preparing new managed care pharmacists

Pourarsalan, immediate past president of the AMCP California affiliate, started the first Texas AMCP student chapter at the University of Houston as a student and has long worked with pharmacy schools. She said new managed care pharmacists should be ready for a market in which “some decisions will be made for us.”

Plans will still run their own cost-effectiveness analyses and pharmacy and therapeutics (P&T) reviews, she said. But knowing that certain drugs will be covered no matter what will shape how plans approach coverage in other drug categories.

“We just have to be more open with allowing certain decisions being made for us,” Pourarsalan said.