What Is PACTA—and Why Does It Matter to Infusion Providers?
You keep hearing about PACTA—but what is it, and why does it matter to your infusion practice? Here’s what every infusion provider needs to know.
What is the Medicare Drug Price Negotiation Program?
Congress created the Medicare Drug Price Negotiation Program through the Inflation Reduction Act of 2022. The program authorizes the Centers for Medicare & Medicaid Services (CMS) to negotiate a Maximum Fair Price, commonly called an MFP, for selected high-spending Medicare drugs.
The program began with drugs covered under Medicare Part D. The first negotiated prices took effect on January 1, 2026. The third negotiation cycle is the first to include drugs payable under Medicare Part B—the benefit that covers many medications administered in physician offices and infusion centers.
CMS selected 15 drugs for the third cycle on January 27, 2026. That list includes Part B therapies used in oncology, rheumatology, gastroenterology, allergy and immunology, neurology, and other specialties. Negotiations are occurring during 2026, CMS is scheduled to publish the negotiated prices by November 30, 2026, and those prices will take effect on January 1, 2028.
This is no longer a distant or theoretical issue. The first Part B drugs have been selected, the negotiations are underway, and providers need time to prepare before the payment changes begin.
What is the timeline for Medicare negotiation of Part B drugs?
- August 16, 2022: The Inflation Reduction Act becomes law and creates the Medicare Drug Price Negotiation Program.
- 2023: CMS selects the first 10 Part D drugs for negotiation.
- 2024: CMS announces the first negotiated prices for those Part D drugs.
- January 1, 2026: The first negotiated Part D prices take effect.
- January 27, 2026: CMS selects 15 drugs for the third cycle, including Part B drugs for the first time.
- During 2026: CMS and participating manufacturers negotiate prices for the third cycle.
- By November 30, 2026: CMS is scheduled to publish the negotiated prices for the third cycle.
- January 1, 2028: Negotiated prices for the first selected Part B drugs take effect.
How are infusion providers paid for Medicare Part B drugs today?
Most community infusion practices operate under a buy-and-bill model. A practice purchases medication before treatment, stores and manages that inventory, administers the therapy, and then bills the patient's health plan.
For most separately payable Part B drugs, Medicare payment is generally based on the drug's Average Sales Price, or ASP, plus a 6% add-on before sequestration. The add-on is not simply profit. It helps practices manage the costs and financial risk associated with purchasing, shipping, storing, preparing, handling, and maintaining inventory for expensive and clinically complex therapies.
Administration payments do not erase those pressures. Community providers also carry staffing, supplies, compliance, prior authorization, billing, bad-debt, and inventory costs while waiting to be reimbursed.
How could the Medicare Drug Price Negotiation Program affect infusion providers?
For a selected Part B drug, the Inflation Reduction Act changes the payment basis from ASP plus 6% to the negotiated MFP plus 6%. Although the percentage remains 6%, the amount to which that percentage applies may be substantially lower.
Here is a simplified example:
- At an ASP of $100, a 6% add-on is $6.
- At an MFP of $60, a 6% add-on is $3.60.
CMS has created an operational process intended to give providers access to the selected drug at the MFP. NICA's concern is different: even if the drug's acquisition-price difference is addressed, the provider's percentage-based add-on still falls from $6 to $3.60 in this example.
An Avalere analysis modeled a 42% to 61% decline in Medicare fee-for-service add-on payments across 10 Part B drugs under different negotiated-price scenarios. It also modeled a 12% to 18% decline in commercial and Medicare Advantage add-on payments if negotiated-price transactions reduce ASP. These are projections based on stated assumptions—not observed results—but they demonstrate the scale of the potential exposure.
CMS also clarified in the CY 2026 Medicare Physician Fee Schedule proposed rule that units sold at the MFP are included in the manufacturer's ASP calculation. Because many commercial and Medicare Advantage contracts are tied to ASP, NICA is concerned that the effect may not remain confined to traditional Medicare and spill over into the commercial market.
Will the Medicare Drug Price Negotiation Program hurt my infusion business?
No one can predict the precise effect on an individual practice today. It will depend on factors including:
- Which drugs your practice administers;
- The final MFP for each selected drug;
- Your acquisition and inventory costs;
- Your payer mix and contract terms;
- Whether and how MFP transactions affect ASP; and
- The cost of safely furnishing each treatment in your setting.
However, infusion providers should take the risk seriously. A practice with significant utilization of selected drugs could see a meaningful reduction in add-on revenue beginning in 2028. Practices operating on thin margins may need to reconsider whether they can stock certain drugs, accept additional financial risk, or continue furnishing some therapies.
That can become a patient-access problem. If community practices stop offering a therapy or close, patients may have to travel farther, wait longer, or receive care in a hospital outpatient department. In many cases, hospital outpatient care is more expensive for Medicare and patients than care delivered in a physician office or independent infusion center.
Why is NICA concerned if lower drug prices are good for patients?
Lower costs for patients and Medicare are important. The problem is not the goal of negotiation; it is the way the Part B payment mechanism can transfer part of the financial effect to providers who did not negotiate the price.
Community infusion providers are not parties to the negotiation between CMS and a manufacturer. Yet because their add-on payment is calculated as a percentage of the negotiated price, they can receive less compensation for the work, infrastructure, and financial risk required to furnish the same therapy safely.
NICA believes Congress can preserve the law's patient and program savings without weakening the community-based providers patients rely on.
What is PACTA?
The Protecting Patient Access to Cancer and Complex Therapies Act (H.R. 4299) is bipartisan legislation introduced in the House by Representatives Greg Murphy, MD (R-NC), Adam Gray (D-CA), and Neal Dunn, MD (R-FL).
PACTA would change how the Medicare program realizes savings on selected Part B drugs:
- Providers would be paid under the existing ASP-plus-6% methodology, or 106% of wholesale acquisition cost when that amount is lower.
- Manufacturers would pay Medicare a rebate reflecting the difference between the ASP-based and MFP-based payment amounts.
- Patient coinsurance would remain based on the lower MFP-based amount.
- The bill would exclude the PACTA manufacturer rebate from ASP calculations.
In plain language, PACTA would keep the provider out of the financial middle. Medicare would still receive the negotiated-price savings from the manufacturer, and patients would still receive lower cost-sharing, but the provider add-on would not be reduced simply because CMS negotiated a lower price.
Would PACTA repeal Medicare drug price negotiation?
No. PACTA would not end the Medicare Drug Price Negotiation Program, stop CMS from selecting Part B drugs, or prevent CMS from negotiating MFPs with manufacturers.
It would change the payment pathway for selected Part B drugs. Instead of reducing the provider payment basis to MFP plus 6%, the bill would preserve ASP-based provider reimbursement and require a manufacturer rebate to Medicare.
That is why NICA describes PACTA as a targeted technical fix rather than a repeal of the Inflation Reduction Act.
Is there anything bad for patients in PACTA?
No. PACTA does not take away the lower negotiated price, raise patient cost-sharing, or stop Medicare from negotiating with manufacturers.
It fixes the part of the law that puts providers in the middle. Patients keep the benefit of cost-sharing based on the lower MFP. Medicare keeps the negotiated savings. Providers continue to receive ASP-based reimbursement so they can afford to acquire and furnish the therapies their patients need.
Without PACTA, the payment reduction could make some community practices stop carrying selected drugs, reduce services, or send patients to more expensive and less convenient hospital settings. PACTA protects patients from that unintended consequence while preserving the purpose of the negotiation program.
Who supports PACTA?
NICA is not raising this concern alone.
In 2025, 67 patient and provider organizations joined a coalition letter supporting H.R. 4299. Organizations representing community oncology, urology, infusion providers, rheumatology, neurology, ophthalmology, and other specialties have warned that reduced Part B add-on payments could make it harder for independent practices to furnish selected therapies.
The Patient Access to Community Treatment (PACT) Coalition brings patient and provider organizations together to protect access to high-quality, cost-effective treatment in community settings. Its materials include state impact reports, provider research, and policy resources on H.R. 4299.
The message from these organizations is clear: lowering drug prices should not come at the expense of the community practices responsible for delivering treatment.
Why is NICA going to Capitol Hill to talk about PACTA?
Federal policy becomes real in infusion centers, medical practices, and patients' lives. Lawmakers need to understand that connection before the first negotiated Part B prices take effect in 2028.
NICA's 2026 D.C. Hill Day will take place September 23–24. Infusion professionals will meet with members of Congress and their staff to explain how Part B reimbursement works, why community sites of care matter, and what could happen if practices cannot sustainably furnish selected therapies.
NICA's policy staff can explain the legislation. Providers bring something equally important: direct experience. A lawmaker is more likely to understand the urgency when a constituent explains what the payment change could mean for a practice and for patients in that lawmaker's district or state.
Hill Day registration for 2026 is closed. NICA Elite members are invited to participate in this annual advocacy opportunity each year.
Why do infusion providers need to make their voices heard?
Members of Congress manage many competing priorities. If they do not hear about an issue from the people it affects who live in their state, they may reasonably conclude that it is not urgent.
Lawmakers cannot hear only from NICA's national office. They need to hear from providers in California, Illinois, Nevada, New Jersey, New York, Pennsylvania, Texas, and across the country. A message from a constituent connects federal policy to local patients, jobs, and access to care.
More than 250 providers have already signed on in support of PACTA. That social proof matters, but each additional practice makes the case stronger. The action is simple, and the timing is important: congressional offices are considering priorities for year-end health legislation now.
What is NICA doing to advance PACTA?
NICA is:
- Educating infusion providers about the Medicare Drug Price Negotiation Program and its Part B implications;
- Meeting directly with lawmakers and congressional staff;
- Bringing infusion professionals to Washington for D.C. Hill Day;
- Working with the PACT Coalition and other patient and provider organizations;
- Submitting comments to CMS and Congress on Part B payment and patient access;
- Organizing state-based provider sign-on letters; and
- Giving providers simple grassroots tools to contact their lawmakers.
What can infusion providers do to support PACTA?
You do not need to become a policy expert. You need to take one concrete action and explain why community infusion access matters where you live and work.
1. Sign the provider letter by Friday, August 28, 2026
NICA is collecting signatures from authorized practice representatives in California, Illinois, Nevada, New Jersey, New York, Pennsylvania, and Texas. More than 250 providers have already signed.
Sign the PACTA provider letter
2. Ask your members of Congress to support H.R. 4299
Use NICA's grassroots advocacy platform to send a prewritten message. Personalize it with one or two sentences about your practice, the therapies you furnish, or what patients would face if local access disappeared.
3. Share a real example
A short, specific story is often more persuasive than a long policy explanation. Tell NICA about a patient who depends on local care, a therapy your practice already struggles to furnish sustainably, or the operational costs that payment policy overlooks. Contact [email protected].
4. Participate in future NICA Hill Days
NICA Elite members are invited each year to bring the infusion-provider perspective directly to Capitol Hill. Watch NICA member communications for the next opportunity.
5. Share this resource
If a colleague asks, “What is PACTA?” send them this page. The more providers understand the issue, the harder it becomes for Congress to overlook it.
The bottom line for infusion providers
Medicare's first negotiated Part B prices will take effect in 2028, but the decisions that determine whether Congress acts are happening now.
PACTA offers a way to preserve Medicare negotiation, lower patient cost-sharing, and protect the community practices that administer complex therapies. NICA supports H.R. 4299 because providers should not become collateral damage in a negotiation they did not conduct—and patients should not lose local access as an unintended consequence.
If lawmakers hear from providers in their states, they are more likely to act. If they hear nothing, they may assume the problem is not important.
Sources and further reading
- H.R. 4299 bill text and status, Congress.gov
- H.R. 4299 official published text, GovInfo
- CMS announcement of the third negotiation cycle and first Part B selections
- CMS Medicare Drug Price Negotiation Program overview
- CY 2026 Medicare Physician Fee Schedule proposed-rule fact sheet
- Avalere: Commercial Spillover Impact of Part B Negotiations on Physicians
- PACT Coalition
