By Susan Cantrell, CEO, Academy of Managed Care Pharmacy
As the Trump administration took office last January, I wrote in Chain Drug Review that there was naturally some uncertainty about the future of American health care policy. Here, in the first month of 2026, a great deal remains in flux as Congress negotiates another large health care package on premium tax credits and pharmacy benefit managers. And there are still other decision points to come that will have crucial downstream impacts.
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If the past year serves as any guide, 2026 may prove to be yet another year where the private sector rises to meet the challenges facing America’s health care system with innovative solutions that could benefit millions of patients in the United States seeking life-changing prescriptions and therapeutics.
2025 was a consequential year, particularly for those of us in the field of managed care pharmacy. Among numerous trends and developments, the Academy of Managed Care Pharmacy (AMCP) kept a close eye on the profound impact of specialty drugs. Our annual “Access, Affordability and Outcomes” report highlighted how specialty drugs now account for nearly 50% of total drug spending. This trend should continue to reshape the American prescription market in the coming year.
And 2026 has already been consequential for many of AMCP’s members and the patients they serve. As part of the Medicare Drug Price Negotiation Program, the Maximum Fair Prices (MFPs) took effect on January 1 of this year.
But certainty in one area — pricing — has yielded greater uncertainty in others. Nearly 20% of pharmacy owners have said that they will not be participating in the program due to their concerns about what MFPs will mean for their ability to operate effectively and recoup costs. If pharmacies choose not to carry MFP drugs, access to these treatments would in fact decrease for patients across America, potentially causing significant downstream implications.
We’ve seen other situations where key participants are choosing to withdraw from certain government programs due to policy changes. Bausch Health recently withdrew from Medicaid and the 340B program, which allows certain hospitals and clinics to purchase prescriptions at a discount. This decision followed the 2024 removal of the Average Manufacturer Price (AMP) cap, which had limited the total rebates that manufacturers were required to pay under the Medicaid Drug Rebate Program.
Bausch Health’s removal of its products had immediate repercussions for formularies. This is another instance where reforms in pricing can yield unintended consequences for access. Should this move become a trend, American patients could witness significant disruptions that could have additional downstream effects on their need for care — and in doing so, impose more of a strain on other segments of the health care industry.
These are just two examples where striking the right balance for patients is far easier said than done. Unintended consequences are often difficult to avoid as participants in our health care ecosystem seek to navigate complexity. But looking ahead to this year, I think there is cause to be optimistic about threading the access-affordability needle, particularly due to the response of several private sector partners.
In multiple instances, we’ve seen innovative attempts to solve for the challenges in this space. For example, on January 1, OptumRx followed through on its commitment to reduce reauthorization (a method of prior authorization) for an additional 40 medications. Cigna’s Express Scripts announced a new non-rebate model late last year, shifting how commercial members will pay for their drugs. It’s still too soon to tell how effective these moves will be; however, I am confident that private sector ingenuity can facilitate solutions that ultimately benefit patients.
These are just two instances where major players in the market are trying to work constructively within our complex system. There are countless more that do not make headlines or a splash in the news, but innovative work conducted by AMCP members and dedicated partners across the broader health care community can have a real impact even in uncertain times.
For example, consider the current state of vaccine policy in the United States. The administration’s changes to vaccine guidance have provoked understandable confusion among payers, providers and patients. This is where pharmacists working together can play a vital role by focusing on the evidence and working to educate patients. In fact, more than a dozen pharmacy associations have banded together to help address pressing issues as they arise.
These types of partnerships are what ultimately give me the greatest hope for the future of American health care. Time and time again, the most effective and durable solutions emerge from the collective efforts of many hands — when all sectors and disciplines within the larger practice of pharmacy collaborate to improve patient health. From the managed care pharmacist carefully developing and optimizing a formulary to the community pharmacist providing lifesaving medications to a customer, there is tremendous value in the collective power of pharmacy.
And that is real cause for optimism.
Susan Cantrell is CEO of the Academy of Managed Care Pharmacy.
