2026 Health Care Outlook: Steve Anderson, NACDS

Editor's Note: In this annual report, leaders of industry
associations present their expectations for pharmacy operators
in the U.S. and Canada, drug distributors, and the
pharmaceutical and over-the-counter product markets, including dietary supplements, for this year. 

By Steve Anderson, president and CEO of the National Association of Chain Drug Stores

The NACDS Total Store Expo was a highlight of 2025. It exuded optimism — defined as the courage to change the future.

That optimism flowed from rising interest in consumer empowered health care; the promise of AI; a broad slate of operational efficiency technologies; and the energy that comes from exploring all of this with peers at an industry-leading forum.

As we head into 2026 — with these dynamics intensifying — I appreciate the invitation to contribute to “Health Care Outlook for 2026” and to hone in on factors that could determine the year’s results.

Trump 2.0 Full Throttle

NACDS matched the Trump administration’s vigorous pace in 2025, and 2026 will demand the same energy. The industry counted on its association to stay on brand: member driven, policy astute and politically savvy. That approach enabled successful navigation of major issues: flu and COVID vaccine access; the threat of pharmaceutical tariffs; direct-to-consumer and most favored nation drug pricing models; and more. 

The NACDS board of directors’ leadership — and the day-to-day engagement of committees, councils and task forces — will fuel effectiveness during the sprint to the midterm elections.

Crisis Drives Services

Pandemics including H1N1 and COVID 19 proved the need to rely on pharmacy services in times of great need. In 2025, the Trump administration keyed on two mounting crises — chronic disease and rural health care — and NACDS again positioned America’s most accessible health care destinations as essential partners.

The new Rural Health Transformation Program is an ideal example. NACDS engaged every state, and more than half have signaled intent to develop pharmacy-related solutions in their use of federal funds. In 2026, NACDS will prioritize helping states implement those solutions. Another federal priority is enactment of the Ensuring Community Access to Pharmacist Services Act, so seniors in Medicare can access certain state-approved services.

Meanwhile, consistent efforts with state partners continue to flourish. In 2025 alone, 35 states enacted 60 bills securing 100 policy gains for scope of practice, payment for services and operational efficiencies.

PBM Reform Politics

Federally, congressional leaders have sustained their resolve to deliver the pharmacy benefit manager (PBM) reform win that is ready for the taking. Political factors beyond the issue itself have blocked near victories twice over the past year, but 2026 could be telltale: Will political chaos prevail again, or will PBM reform be enacted amid pressure to address prescription drug affordability and to safeguard pharmacy access? The costs of inaction are intensifying, with Americans losing four pharmacies daily and 97% saying they expect actions to prevent closures.

While the federal government must do its job, states continue to make a positive impact. In 2025, 38 states enacted 79 bills resulting in 152 policy wins in reimbursement, PBM reform, access and accountability.

On Point Innovation

NACDS was prescient in prioritizing pharmacy data interoperability and Food Is Medicine within its Health and Wellness Innovation strategy, launched back in 2022. In 2025, the Trump administration’s “Make Health Tech Great Again” campaign included interoperability as a focus, and its Make America Healthy Again vision created openings for nutrition and Food Is Medicine. NACDS has a head start on these topics and has pharmacy well positioned.

A core asset is the association’s partnership with the Milken Institute. Our 2025 project — Advancing Health Through Expanded Access to Pharmacy Based Care — will remain the 2026 road map for comprehensive actions needed to leverage the innovative power of NACDS members.

Employers’ Importance

NACDS is reaching decision makers beyond government — including employers who want to keep their teams healthy while reducing health care costs. Working with the Health Action Alliance in 2025 created a springboard for 2026. Findings: 89% of U.S. workers view pharmacy-based care positively, and 71% say it would improve their health, yet there is overwhelming lack of awareness about the range of services pharmacies can offer. Many employers remain unfamiliar with the proven return on investment these services deliver. Helping them is among our marching orders for 2026.

Keen Issue Radar

Beyond the high-profile issues, public policy success also demands a discerning eye and tenacious spirit — addressing threats that could prove severe. As in 2025, NACDS will remain focused on preventing federal legislation that would blow a cannon hole through the Stark Law’s consumer protections and open physician prescribing for all Medicare Part D medications. NACDS will work with legislators to address interest in country of origin information related to prescription drugs — without unleashing harmful unintended consequences. Preserving pharmacies’ ability to serve the nation’s most vulnerable individuals in the 340B program also tops the list. In advocacy, the harms prevented are as vital as the progress secured.

See You at NACDS

One of the biggest determinants of success will be retailer/supplier collaboration. NACDS looks forward to welcoming you to the association’s meetings and conferences. Together, we will shape how all of this — and more — turns out. As often seems to be the case, our “Health Care Outlook for 2026” will serve as the prelude to our “Health Care Outlook for 2027.” Let’s savor — and capture — the opportunity to write it together.

Steve Anderson is president and CEO of the National Association of Chain Drug Stores.