Last week, the Centers for Medicare & Medicaid Services released draft program instructions outlining how it will identify and publish a list of "essential pharmacies" beginning in 2028, as required by the Consolidated Appropriations Act of 2026. NCPA plans to submit comments, but individual pharmacy owners and stakeholders who would like to review the proposal must submit any comments by no later than 11:59 p.m. ET on Nov. 19.
This proposal could have significant implications for independent community pharmacies, particularly those serving rural and underserved areas. It establishes a process for Medicare Part D sponsors to report pharmacies affiliated with plan sponsors and PBMs, which CMS will use to determine which independent, non-affiliated pharmacies qualify as essential pharmacies. The proposal includes definitions for "affiliate" and "pharmacy benefit manager." CMS is also seeking stakeholder feedback on how to measure pharmacy proximity, including whether to use straight-line or driving distance methodologies. Final program instructions will be released after considering public comments submitted.
You can find the draft instructions here; the linked document explains how to submit comments.
