Medicare Negotiated Price Exposure Calculator

1. Add each Part B drug you give with its yearly Medicare units, payment per unit today, and your acquisition cost per unit.
2. Enter the negotiated price you expect, or a % below ASP, and the share of any price gap you expect the manufacturer to refund.
3. Read the margin today, the margin at the negotiated price, and the dollars and share at risk, drug by drug and in total.

• ASP per unit = payment per unit today ÷ (1 + add-on)
• Negotiated price per unit = the price you enter, or ASP × (1 − % below ASP)
• New payment per unit = negotiated price × (1 + add-on), which is 106% of the negotiated price
• Your cost per unit after the refund = acquisition cost − (acquisition cost − negotiated price) × share you get back, when your cost is above the price
• Margin today = units × (payment today − acquisition cost)
• Margin at the negotiated price = units × (new payment − cost after the refund)
• At risk = margin today − margin at the negotiated price. % at risk = at risk ÷ margin today.

With the example values: drug B is paid $265 a unit today, so ASP is $265 ÷ 1.06 = $250, and it costs $252. Margin today is 600 × $13 = $7,800. At an expected price of $150, Medicare pays $159, and the refund brings the cost down to $150, so the margin is 600 × $9 = $5,400. That is $2,400 at risk, 30.8%. Across the three example drugs, $4,050 of $15,300 is at risk, 26.5%. If no refund came back, drug B would lose $93 a unit. The examples are made up and are not real drugs or prices.

• 2028 is the first year that includes Part B drugs. CMS announced the 15 drugs for this round on January 27, 2026, and any negotiated prices take effect January 1, 2028. CMS announcement.
• The prices are not out yet. CMS has until November 30, 2026 to publish any agreed prices for 2028. They were not on CMS's negotiated prices page when we checked, so this tool asks for your own assumption. CMS timeline (PDF).
• Medicare pays 106% of the negotiated price. For a selected Part B drug, the payment limit becomes 106% of the negotiated price instead of 106% of ASP, so the 6% add-on shrinks with the price. CMS Part B drug payment limits overview (PDF).
• Your cost is meant to drop too. The manufacturer must either sell to you at the negotiated price or refund the difference between your cost and that price. CMS's July 16, 2026 guidance on how that works is still a draft. CMS draft guidance fact sheet (PDF).

A September 2026 Milliman white paper commissioned by the National Infusion Center Association, built from 2023 Medicare claims, estimated that paying on negotiated prices cuts Part B provider reimbursement for non-oncology drugs by $9.2 billion over 10 years, or 16.1% of net cost recoveries.

The paper defines net cost recovery as what the claim pays (the allowed amount, reduced for sequestration) minus the cost to buy the drug and the cost of providing the service: in other words, the margin. It is one modeled estimate with its own assumptions about which drugs are selected and at what price, not a forecast for your center. Read the Milliman white paper (PDF, infusioncenter.org).

• Use published prices when they exist. Until CMS posts the 2028 negotiated prices, any price or % reduction here is your assumption. Replace it with the published figure, converted to your billing unit.
• Only count Medicare units. The rule above is Medicare's payment. Medicare Advantage plans and commercial payers pay under their contracts, though some analysts expect negotiated prices to pull ASP down over time.
• The refund is the cash risk. If the manufacturer refunds the price gap after you buy, you carry the difference until the money arrives, and the refund may be based on a standard price rather than your actual invoice. Lower the refund share to see what a shortfall does.
• Sequestration and patient share still apply. Medicare's 2% sequestration cut and the patient's 20% coinsurance apply on top of this. The tool compares payment limits before those, the same way on both sides.

The buy-and-bill margin calculator shows one administration's margin after waste and patient balances. Drug margin per infusion is defined in the infusion center KPI glossary, and the WeInfuse reporting guide covers where drug units and payments live.