Impacts for medically integrated dispensing in 2026 and beyond

It takes roughly three weeks from the time a claim is adjudicated to receive full reimbursement, including the rebate – a long window for practices managing cash flow. While much of the current conversation centers on oncology and urology, other specialties will feel these pressures as well.

Reimbursement trends for specialty brand medications have steadily decreased over the last several years, with no signs of leveling off. In 2026, 28% of claims were reimbursed at least 8% below wholesale acquisition cost (WAC) – or 23.33% below the average wholesale price (AWP). At the same time, pharmacy benefit managers (PBMs) and payers are pushing contract structures tied to cost-plus, predictive acquisition cost (PAC), national average drug acquisition cost (NADAC), or dispensing fees layers on top of acquisition cost. For these models to be viable, the broader reimbursement model will need to evolve.

Specialty generics add another layer of complexity. Their reimbursement is far less transparent, and the only way to understand the fee is to process the claim. Most fee schedules pay the lower of an AWP-based formula or the maximum allowable cost (MAC), but MAC values are proprietary to PBMs and are not disclosed.

The Inflation Reduction Act’s Maximum Fair Prices (MFP) provisions – along with shifting economics for brands, generics, and biosimilars – also have an impact on reimbursement.

For many therapeutic areas, 2026 did not bring dramatic change. Some MFP-listed drugs are mature brands with biosimilars or generics already available and are expected to come off the list in 2027. Dispensing a biosimilar or generic avoids the MFP/MTF process entirely, eliminating the wait for rebate payments.

The impact is expected to increase more meaningfully in 2027, particularly in oncology. As several cancer therapies are added to the MFP list, MIDs should closely monitor the evolving landscape and prepare for greater reimbursement complexity. Rebate exposure may exceed what practices are seeing in 2026, and the loss of patent protection for two oncology drugs will further shift treatment and dispensing dynamics.

Beacon MFP is a free web-based platform that helps pharmacies manage, track, and reconcile MFP manufacturer refund payments. It also allows practices to submit good-faith inquiries if they believe a payment is incorrect or missing. Registering now will help practices prepare for 2027 and gain a better understanding of forthcoming rebates. 

Similarly, all practices – even those that do not expect to dispense MFP-listed drugs – should register with the Medicare Transaction Facilitator to ensure they are fully aligned with CMS requirements.

Limited distribution networks continue to evolve. The Oncology Optimized Limited Distribution Model, which excludes PBM-affiliated mail order pharmacies, has shown meaningful benefits for MID programs. As of April 2026, 44 unique drugs had adopted OOLD, and studies show that MID practices captured nearly 89% of those fills.

Additionally, patient assistance trends are shifting as well. In prostate cancer, for example, claims for brand therapies increased by 18% from 2025 to 2026, yet the percentage of claims supported by patient assistance declined. Meanwhile, Medicare Prescription Payment Plan (M3P) claims rose by more than 400%. Organizations such as NCODA publish and track data demonstrating the value of MID models in adherence, access, affordability, time to fill, education, patient satisfaction, and cost avoidance. Prime Therapeutics also highlights savings from oncology MIDs on its website.

Finally, audit risk remains an important consideration. Certain specialty medications are required to be dispensed in their original container, and breaking bottles for these medications may lead to audit scrutiny. Patient prescription pickup of 10 days or more after the drug has been billed may also result in recoupment. As reimbursement tightens, payers are monitoring these details more closely.

Cencora’s Specialty Practice Rx Services helps community practices implement and optimize MID programs. MID makes it easier for patients to fill prescriptions and allows practices to capture revenue from specialty medications and supportive care products – revenue that may otherwise be lost to retail or specialty pharmacies.

With more than 2,900 physicians and hundreds of dispensing sites, our program is the largest and longest tenured MID program for community practices. Our services are delivered by a team of pharmacists and pharmacy technicians who work with your practice to implement ether a licensed pharmacy or physician dispensing program, supported by comprehensive services, software, and enhanced analytics.

To set up or optimize an MID program in your practice, email info@intrinsiQ.com.