Several pharmacy and pharmacist organizations have praised the pharmacy benefit manager (PBM) reforms in H.R. 7148, the Consolidated Appropriations Act passed by the U.S. House of Representatives on Jan. 22.
The National Community Pharmacists Association, the National Association of Chain Drug Stores, the National Association of Specialty Pharmacy, and the American Pharmacists Association were among the groups urging quick passage of the appropriations bill. At press time, the bill had passed the House and was awaiting further action by the Senate.
“Congressional leaders and appropriators of both parties have included some long overdue and urgently needed PBM reforms as part of the final four spending bills for FY2026,” the organizations said in a Jan. 21 joint announcement. “These reforms are of critical importance to American patients and their pharmacists and pharmacies. Medicare recipients should be able to access the care and prescriptions they need at their chosen pharmacy without PBMs and plan sponsors getting in the way. We are heartened to see that many of the needed reforms have been attached to the latest spending bill. … We announce that each of our organizations strongly endorse this ‘minibus’ which includes important PBM reforms to Medicare plans, and urge members of Congress to vote ‘yes.’”
The pharmacy groups said PBMs “that inflate Americans’ prescription drug costs, force pharmacy closures, and block access to Americans’ pharmacists and pharmacies of choice must be stopped. … This would be the first major PBM reform in Medicare Part D to pass in nearly 20 years, and as such, we reiterate that now is the time to pass these reforms.”
The appropriations act would require the Centers for Medicare & Medicaid Services (CMS) “to define and enforce ‘reasonable and relevant’ Medicare Part D contract terms, including information about reimbursement and dispensing fees, and establish an appeals process for pharmacists to dispute terms that do not follow the reasonable and relevant standards,” the organizations’ announcement said.
The bill would also enable CMS to “track payment trends to pharmacies and pharmacy inclusion in PBM networks, including a designation of essential retail pharmacies” and would prohibit 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.”
