WASHINGTON — Momentum is growing for the most comprehensive federal action on pharmacy benefit manager reform to date after the U.S. House of Representatives approved the Consolidated Appropriations Act of 2026, a must-pass funding package that includes significant changes to PBM practices across Medicare and the commercial market. The bill now moves to the Senate ahead of a Jan. 30 government-funding deadline, with pharmacy organizations urging lawmakers to act swiftly and send the legislation to the White House.
In a memo circulated to chain members following House passage, National Association of Chain Drug Stores President and CEO Steven C. Anderson described the measure as “the most substantial federal action ever related to PBM reform,” noting that it reflects years of coordinated advocacy by the pharmacy community.
“Congress has come close to enacting PBM reform in recent years, only to have near-wins disrupted by political factors beyond the issue itself,” Anderson wrote. “Now, as Congress works against a January 30 deadline, PBM reform, and the Americans and pharmacies counting on it, has another prime opportunity for enactment.”
Broad Industry Support
Support for the House-passed bill has been quick and bipartisan across the food and pharmacy sectors. FMI – The Food Industry Association praised lawmakers for advancing reforms aimed at reducing anticompetitive PBM practices that have increasingly strained supermarket pharmacies.
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“These reforms are urgently needed, and the House has taken an important step,” said FMI Chief Public Policy Officer Jennifer Hatcher, urging the Senate to move expeditiously. “Patients, pharmacies and the communities they serve cannot afford further delays.”
Independent pharmacists echoed that urgency. The National Community Pharmacists Association called the provisions “long overdue,” framing them as the first major Medicare Part D PBM reform to clear the House in nearly two decades.
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“PBM-insurers have managed to get away with anticompetitive, harmful business practices for far too long,” said NCPA Senior Vice President of Government Affairs Anne Cassity. “We need to get this through the Senate and to the president’s desk as quickly as possible.”
What the Bill Does
At the heart of the legislation are historic Medicare reforms aimed at addressing PBM conduct while staying flexible to changing business models. The bill sets new standards for pharmacy network participation and contract terms, requires greater transparency and pass-through provisions for PBM compensation, and establishes a formal complaint and enforcement process managed by the Centers for Medicare & Medicaid Services.
Key Medicare provisions include:
- Assured pharmacy access and choice by requiring Part D plans to allow any pharmacy willing to accept standard terms to participate in networks.
- “Reasonable and relevant” contract standards covering reimbursement, fees, audits, and performance measures, with CMS oversight and penalties for noncompliance.
- PBM accountability measures mandating full pass-through of rebates and price concessions, limiting compensation to bona fide service fees, and expanding disclosure and audit authority.
Implementation is phased, with CMS stakeholder input beginning in 2027 and full application to Medicare Part D plans starting in 2029. The bill also allocates $188 million to CMS for enforcement and oversight.
Beyond Medicare, the legislation expands PBM oversight into the commercial market, including new transparency reporting, audit rights, and requirements that PBMs remit 100% of drug-related payments to group health plans. These provisions would generally take effect for plan years starting approximately 30 months after enactment.
Advocacy Push Intensifies
NACDS credited its members’ targeted outreach and use of its RxIMPACT action alerts for helping advance the bill in the House, and called on pharmacies to continue pressing senators as the legislation moves forward. NCPA, meanwhile, highlighted its revived “Finish the Fight” campaign, which has generated tens of thousands of messages to Congress in support of PBM reform.
With Senate consideration expected soon, pharmacy advocates say the combination of bipartisan support, a funding deadline, and unified industry messaging has opened a rare opportunity for reform.
“As Congress turns to the Senate, the message from pharmacies is clear,” Anderson wrote. “On to the Senate for must-have PBM reform.”
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