SYNTHETIC DEMONSTRATION DATA — no real pharmacy, patients, claims, or payments. Prices are representative of published 2026 WAC / MFP figures.
RxGuard
MFP Refund Ledger
Dogwood Pharmacy · Vienna, VA · NCPDP 3947261
Ledger as of Tue, Sep 2, 2026
Since Jan 1, 2026, this pharmacy buys the ten Medicare-negotiated drugs at roughly list price (WAC) but is reimbursed against the lower Maximum Fair Price. The manufacturer owes the gap on every fill as a refund routed through CMS’s Medicare Transaction Facilitator — due within 14 calendar days of claim-data transmission. RxGuard reconciles every fill against the bank feed, tracks the working capital that is tied up while refunds are outstanding, separates the exceptions that need different responses, and scores each manufacturer against the statutory window — because a single late refund is a billing question, while a manufacturer that misses it habitually is a compliance matter. Every claim carries a dispute-ready evidence pack; every manufacturer with a pattern carries a referral pack.

Working capital tied up in unpaid refunds

Daily balance the pharmacy is fronting: every fill adds its refund to the float on the day its claim data is transmitted, and removes it on the day the deposit clears. Short payments never clear.

Past the 14-day standard Inside the window Average floated

Who is holding your cash

Every manufacturer on the negotiated list is a counterparty this pharmacy extends credit to, whether it meant to or not. Payment behavior is the risk; total exposure across everything you stock from them is the size of it. Click a row for the exposure and what can be done about it.

Manufacturer Claims Refunds owed Products Paid within 14 days Days to refund Outstanding Assessment

Where a slow payer is actually actionable

A pharmacy cannot switch manufacturers for a patented molecule, so payment behavior only matters where it meets a decision the pharmacy actually controls: what to stock, how deep, and which product to suggest when a prescriber is open to either. Grouped by therapeutic class below.

This is a stocking and working-capital view, not a clinical recommendation. Therapeutic equivalence is the prescriber’s call, and these products are not interchangeable by default. Payment behavior belongs in the conversation only where the clinical choice is already open.

Exceptions the ledger separates

“Unpaid” is not one thing. Each of these needs a different response, and two of them are invisible in a reconciliation report that only matches totals.

Outstanding refunds by age

Age is measured from the refund due date (transmission + 14 calendar days).

Weekly refund cycle

Refunds falling due each week vs. deposits actually received that week.

Received Due per 14-day standard
Rx / Fill Drug Acquired (WAC) MFP Refund expected Received Status

What this becomes in 2027

Ten negotiated drugs are in effect today. Fifteen more take effect Jan 1, 2027, and the 340B rebate pilot routes a second manufacturer-refund stream through the same facilitator.

The 2027 figures scale this pharmacy’s observed refund-per-fill and payment behavior across the announced drug list. They are an extrapolation, not a forecast.

Data provenance

Exactly where this demo touches reality — and where it doesn't.

Real

  • The Medicare Drug Price Negotiation Program and its Jan 1, 2026 effective date; manufacturer refunds routed through the CMS Medicare Transaction Facilitator.
  • The 14-calendar-day refund standard (42 U.S.C. §1320f-2 and CMS program guidance).
  • All eight drugs shown, matched to their actual manufacturers, are among the ten selected drugs.
  • The MFP column holds CMS’s published 2026 negotiated prices for a 30-day supply ($231 Eliquis … $2,355 Enbrel).
  • The cash-flow pain is documented: NCPA estimates roughly $11K/week floated per pharmacy, with real-world payment averaging ~21 days against the 14-day standard — this ledger averages — days to refund, in that range, and floats — per week — somewhat above NCPA’s per-pharmacy average, since the modeled panel is deliberately Medicare-heavy.

Real, but simplified

  • “Expected refund = WAC − MFP” is the standard industry simplification; the true basis is the dispenser’s actual acquisition price, usually WAC minus a wholesaler discount.
  • WAC figures are representative list prices, not verified current WACs — the MFP side is exact, the WAC side is approximate.
  • The 14-day clock here starts at MTF transmission; CMS guidance carries receipt-and-verification nuance a real system must model.
  • Every fill is modeled as a retrospective refund — the dominant 2026 pattern, though prospective effectuation exists.
  • NDCs are correctly formatted and largely match real products, but were not verified against the FDA NDC directory.
  • Therapeutic classes are assigned here, and only two pairs are marked comparable (the two factor Xa inhibitors, and the two SGLT2 inhibitors). That is a coarse judgment: even within a class these products differ by indication, dosing and evidence base, and nothing here should be read as a clinical equivalence claim.
  • Carrying cost assumes a 9.5% line-of-credit rate. The interest is modest at this volume; the binding constraint for an independent is the working capital itself, not the interest on it.

Fabricated

  • The pharmacy, its address and NCPDP number; every Rx number, invoice line, MTF reference, ACH trace, adjudication ID, fill date, deposit, and short-payment — all generated deterministically from a fixed seed.
  • The letter’s addressee (“Medicare MFP Effectuation Team”) is an invented label, and the letter paraphrases the refund requirement rather than citing it.
  • Every manufacturer’s payment behavior is invented. The compliance scorecard is the honest output of a made-up input: each company was assigned a payment profile, and the ledger reports what those profiles produce. Nothing here describes how any real manufacturer actually pays.

Sources: CMS pharmacy/dispensing-entity MTF fact sheet (PDF) · CMS Medicare Drug Price Negotiation Program · NCPA/ASCP joint recommendations (Jun 2025) · NCPA comments to CMS (Aug 2026)