Congress includes APhA-backed PBM reforms in end-of-year spending package

WASHINGTON, D.C. — The American Pharmacists Association released the following statement after Congress’s response to the hundreds of APhA members’ pleas to include major federal PBM reforms in the end-of-year spending package set to pass Congress this week. 

Led by APhA’s End Harmful Practices of PBMs Now campaign, hundreds of APhA members called, wrote, and met with their members of Congress to educate them on how PBMs’ abusive and unchecked business practices have directly led to pharmacy store closures that have created unbearable pharmacy deserts that have denied the only source of health care services to many underserved and rural areas of the country. 

“Pharmacy is united in standing up for our patients to reform the broken PBM marketplace. For years, APhA has advocated for these long overdue reforms to begin to stop PBMs’ harmful business practices that have robbed many communities of the necessary health care services they have come to rely upon,” said Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP, executive vice president and CEO of APhA. “We thank our congressional champions who understand there is more work to be done. APhA and our colleagues will continue to lead the fight for meaningful PBM reforms to keep our nation’s pharmacy doors open for our patients and bring real transparency and accountability to the health care marketplace.” 

Key APhA-backed PBM reforms in the end-of-year spending package include: 

• Sec. 112. Ensuring accurate payments to pharmacies under Medicaid. Requiring a survey of retail community pharmacy drug prices to help establish benchmarks for Medicaid reimbursement to pharmacies that can be used to ensure fair reimbursement to pharmacies in Medicaid-managed care and in the commercial markets, beginning six months after enactment of the spending package, beginning the first quarter six months after enactment of the spending package. 

• Sec. 113. Preventing the use of abusive spread pricing in Medicaid. Banning PBM spread pricing in Medicaid-managed care (the overcharging Medicaid and underpaying of pharmacies) that has created PBM profits at the expense of states and patients, beginning in mid-2026. 

• Sec. 226. Assuring pharmacy access and choice for Medicare beneficiaries. Requiring the Centers for Medicare and Medicaid Services (CMS) to define and enforce “reasonable and relevant” Medicare Part D contract terms, including information about reimbursement and dispensing fees, and an approach by which “any willing pharmacy” can participate, beginning January 1, 2028. 

• Sec. 227. Modernizing and Ensuring PBM Accountability. Delinking PBM profits from the fake list prices set on prescription drugs for plan years, beginning after January 1, 2028. 

• Sec. 901. Oversight of pharmacy benefit management services. Implementing PBM transparency measures to provide clear information on drug pricing, rebates, and discounts in the commercial marketplace for plan years, beginning two and half years after the enactment of the spending package. 

• Sec. 902. Full rebate pass through to plan. Requiring PBMs to fully pass through 100 percent of drug rebates and discounts to the employer or health plan. 

###