After years of NCPA advocacy, the president has signed into law provisions instituting the first meaningful federal reforms to pharmacy benefit manager practices. The bill requires the Centers for Medicare & Medicaid Services to define and enforce "reasonable and relevant" Medicare Part D contract terms; allows CMS to track payment trends to pharmacies and pharmacy inclusion in PBM networks, including a new designation of essential retail pharmacies; and prohibits PBM compensation in Medicare Part D from being tied to the manufacturer's list price of a drug in an effort to reduce drug prices and save money for taxpayers.
This NCPA priority legislation comes after years of advocacy and represents the first major change to Medicare Part D in two decades. The provisions are included as part of a larger bill funding the Department of Health and Human Services signed by President Donald Trump.
"We're grateful to our champions in Congress and to the president for seeing these provisions across the finish line in the face of tremendous pressure by PBM-insurers to maintain the status quo," NCPA CEO Douglas Hoey said in a statement. "The pharmacy payment model is changing, and we'll keep fighting to secure the best possible outcomes for independent community and long-term care pharmacies and their patients."
Enactment of these provisions follows countless outreach efforts by NCPA and our members over the years, including phone calls and other messages to Capitol Hill, pharmacy visits with legislators and their staff, and meetings.
Our recent Finish the Fight campaign generated almost 100,000 letters to Congress from patients demanding PBM reform. NCPA relaunched the campaign in December with fresh digital advertising assets (like this hilarious ad calling PBMs out for their fat-cat behavior!). In just six weeks, more than 12,000 letters were delivered to Congress. In 2024, the campaign helped send in over 80,000 messages.
You can read a high-level summary of the PBM reform provisions included here, a more in-depth review here, and our full statement here.
