In a major win for independent community and LTC pharmacies across the nation, Congress included key PBM reform provisions in its fiscal year 2026 appropriations bill for the Department of Labor and the Department of Health and Human Services — including requiring the Centers for Medicare & Medicaid Services to define reasonable and relevant contract terms under Medicare Part D, create a process for pharmacies to report contract violations, and enforce penalties; the agency will receive $188 million to implement this program. This is the first major legislative change to Medicare Part D directly impacting pharmacy in almost 20 years.
Another provision would delink PBM compensation from the price of a drug in Medicare Part D. The bill also introduces a designation for "essential retail pharmacies" that will allow CMS to track payment trends to pharmacies deemed essential and their inclusion in PBM networks.
This important legislation is taking the fight to the PBMs in lowering drug prices, improving pharmacy access for patients, and leveling the playing field for community pharmacy. We are very grateful to our pharmacy champions, including Rep. Buddy Carter (R-Ga.), Sens. Mike Crapo (R-Idaho) and Ron Wyden (D-Ore.), and other leaders in Congress for including this language in the funding bill. NCPA strongly supports the legislation, and we will urge all members of Congress to vote yes when the bill comes to the floor at the end of this week.
You can read our full statement here.
