PALM BEACH, Fla. — The retail pharmacy industry is gathered here for the National Association of Chain Drug Stores Annual Meeting at a critical juncture.
With the federal government still yet to act on PBM reform, and retailers facing mounting competition from online companies and other trade classes, meeting attendees will have much to contemplate.
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At the same time, the gathering will provide the reassurance of a traditional annual industry highlight, including the NACDS chairmanship succession. This year will see the torch passed to Walgreens chief pharmacy officer Rick Gates from Kevin Host, senior vice president of pharmacy at Walmart.
“Ultimately, the steps we take now will shape the future — we must unite as one voice across independent pharmacies, chains and practitioners to drive critical reforms,” says Gates. The industry “must unite to expand access, modernize care and ensure every community receives the support it deserves.”
The cost of inaction on PBM reform is escalating, says NACDS president and chief executive officer Steve Anderson.
“Nearly four pharmacies are closing daily, and since the end of the last Congress in December hundreds of millions of dollars of potential savings for Americans have gone unrealized,” Anderson says.
Congress created a solid package of PBM reforms for consideration in the government spending bill in December, he emphasizes, with support from leadership, committee chairs, Republicans and Democrats.
Jeffrey Woldt
“The reforms would be sound policy,” he says. “They would confront drug-price inflation for Americans, safeguard pharmacies from vicious PBM tactics, and prevent health care from becoming more remote and out of reach.”
The spending bill that included these needed reforms ultimately did not receive a vote for reasons other than PBM reform, he notes. “It is important that President Trump and his administration make clear that Congress needs to advance the PBM reforms that are ready to go.”
Trump made two comments in national media appearances within one week’s time about the need to confront these “middlemen,” Anderson points out.
Advancing the reforms is one of NACDS’ key recommendations to the administration under the rubric, “Four Wins to Make America Healthy Again.”
“PBM reform is essential for Americans’ health,” says Anderson.
EXCLUSIVE: NACDS president and CEO Steve Anderson discusses the association’s gains on a range of priorities
Q: How impressive and effective has the momentum for reform at the state level been? Can it eventually make the push for federal reform irrelevant?
ANDERSON: PBM reform requires an all-levels and all-branches of government focus. Everyone needs to do their jobs. State lawmaking has been important and impressive. NACDS has played a major role, as have state associations and member companies. In 2024 alone, 24 states enacted 33 bills, leading to the adoption of 74 policy changes that align with NACDS’ PBM reform and reimbursement policies. Before that, from 2021 to 2023, states enacted more than 130 new PBM reform laws. Equally important is the implementation, enforcement and oversight of these new state laws. That point needs to be emphasized — strong enforcement is a must. Federal reforms will remain necessary, too. For one example, federal action is needed to bring about reforms that are important for seniors in Medicare and for the pharmacies that serve them. What is really interesting is that American voters expect both their federal and state legislators to take action. In a poll conducted by Morning Consult, commissioned by NACDS, 76% of American voters say legislation in Congress is important to address concerns about PBMs, and 76% say legislation in their state legislature is important. The PBMs are ramping up their rhetoric and advocacy to try to block reforms — and they are even using despicable tactics like trying to call PBM reform a “tax.” State officials need to stand strong for people and pharmacies.
Q: Has all the pressure for reform led to concessions from the PBMs themselves, like cost-plus programs? Could moves like this from the PBMs lead to the industry sufficiently reforming itself?
ANDERSON: The federal and state governments need to remain focused on accomplishing reform. This problem of PBMs profiting exorbitantly while Americans and their pharmacies suffer from PBM tactics is about 15 years in the making. The costs of inaction by the federal government on PBM reform are escalating and intensifying. Without discussing any of the announcements by specific companies, I would just say there is no reason for any branch or any level of government to further delay reforms. Every day of delay means more dollars flowing to the middlemen, at the expense of people and their pharmacies. Members of Congress understand this. When the PBMs were called to testify on Capitol Hill last year, before the House Oversight and Accountability Committee, Republicans and Democrats did not take kindly to the PBMs’ comments that were intended to argue that reforms are not necessary — and members of Congress even encouraged the PBMs to correct their statements for the record. This year, when now-Secretary of Health and Human Services Robert F. Kennedy Jr. was going through his Senate confirmation hearing, Senators made clear that PBM reform legislation is needed and PBM self-regulation would not be sufficient. It should not be lost on anyone that the PBMs are turning up the volume on the concept of self-regulation since they saw how close federal reforms were to being enacted in the prior Congress.
Q: What’s the potential for scope of practice legislation?
ANDERSON: There are two important points here. First, discussions of scope of practice relate to state policies about the array of services that pharmacists are allowed to perform for patients. Second, at the federal level, and separate from scope of practice, there is an effort under way to ensure that seniors in Medicare can access services that states allow pharmacists to perform. That would be accomplished by allowing payment for pharmacists’ clinical services in Medicare. In terms of scope of practice at the state level, we continue to make really positive progress. Recently, NACDS has focused on codifying at the state level the pharmacist-provided services that were allowed during the pandemic. Almost every state has taken some action in this regard, but there still is work to be done for the good of patient care. In 2024 alone, 27 states enacted 48 bills, creating 120 policy changes that align with NACDS priorities. At the federal level, NACDS continues to work with the Future of Pharmacy Care Coalition to urge enactment of the Equitable Community Access to Pharmacist Services Act. Again, this is not scope-of-practice legislation. Rather, it would ensure seniors in Medicare have access to state-approved pharmacist services. It is time for that bill to be enacted — one-third of the Congress co-sponsored it in the last Congress.
Q: Do you have thoughts on the overhaul of HHS, in terms of both mission and personnel?
ANDERSON: One of the strengths of NACDS is the association’s member-driven approach to all that we do. When NACDS engages on issues, our actions are based on real-world insights from member companies about how policies are playing out in communities throughout the nation. With so many developments emerging from the Trump administration so quickly, NACDS is maintaining a proactive footing with members to learn what they are hearing and seeing. Certainly NACDS is making it a priority to identify any potential disruptions to pharmacy patient care and to policy development and implementation — and, as we always do, we will take action as needed. In just one example, NACDS worked with members to evaluate and engage on specific actions during the presidential transition that could have slowed preparations and hindered readiness for the 2025-2026 flu season. In another example, NACDS is maintaining contact with the administration to ensure that we maintain progress on one issue in particular that had been further harming pharmacy reimbursement. We are staying on top of all our issues, and identifying new ones as they emerge.
Q: Can you discuss the gains NACDS has made in propelling the Health and Wellness Innovation Initiative, including AARP’s participation in the Nourish My Health campaign and the momentum for Food as Medicine?
ANDERSON: In 2024, NACDS made it a priority to be recognized as a leader within health care on issues surrounding longevity and on enhancing health span in addition to life span so people can be healthy throughout their lives. In other words, we want to improve the quality of life as we age, rather than just the number of years we live. Some call this “Medicine 3.0.” We have accomplished the objective of asserting NACDS’ leadership. Earlier this year, AARP hosted its Global Thought Leadership Conference, titled “Unlocking Health Longevity: A Blue Print for Thriving with Age,” and I had the opportunity to speak. That is where we announced that AARP has joined NACDS’ Nourish My Health initiative, a national public health education campaign about the link between nutrition and chronic disease prevention. Since last year’s NACDS Annual Meeting, the campaign has added, in addition to AARP, the Alzheimer’s Association, March of Dimes and the Alliance to End Hunger. They joined the American Cancer Society, the American Diabetes Association, and the Food is Medicine Institute at Tufts University’s Friedman School of Nutrition Science and Policy. That is outstanding progress and growth — and another example is the strong and formal engagement of NACDS chain and supplier members. This growth parallels our progress on Food Is Medicine specifically, in which NACDS and pharmacy now are seen as essential partners for the path forward.
Q: How is NACDS supporting the front-end business of retail members?
ANDERSON: One of the issues on the front burner right now is the tariff situation. As I talk with you, the president just announced new tariffs, and NACDS just reported to chain members on the specifics and on some of the ramifications for their operations — including the front end. In this regard, we also recently concluded an NACDS Live which addressed the impact of tariffs on both retailer and supplier members. This is an issue we will remain focused on as it evolves. Meanwhile, related to front-end success, we are looking forward to another highly successful NACDS Annual Meeting, where chain and supplier members will be working on that very topic, among other important agenda items. In addition to the valuable Strategic Exchange Appointments, the Meet the Industry programming has a tremendous lineup once again, and those discussions between retail leaders and suppliers go a long way. When we talk about NACDS’ work on front-end topics, NACDS’ gold-standard meetings and conferences have to top the list. They also include the NACDS Total Store Expo and the NACDS Regional Chain Conference. Retailers who want to really advance the front end, and the entire store for that matter, need to be in San Diego this August for the NACDS Total Store Expo. This is where the industry gets business done. So much of NACDS’ programming — for the conferences and beyond — is driven by the NACDS Retail Advisory Board (RAB). The RAB serves as a valuable sounding board for the industry. We appreciate the work of the supplier members and retailers who keep us on top of all the emerging issues.
Q: Can you offer some thoughts on Jim Whitman’s legacy?
ANDERSON: First, we are turning the Board of Directors Dinner — on Tuesday during the NACDS Annual Meeting — into a celebration of Jim and Karen Whitman. We will see everyone there to celebrate Jim’s nearly five decades of service to NACDS, and his June retirement from the association. Can you imagine something more fitting than honoring Jim at an event that he has shaped so significantly and that he has personified in so many ways? Jim built a legacy on his relentless pursuit of excellence in member service, and he and the team have created events that are the gold standard in the industry for networking and business growth. That legacy is a total commitment to the success of chain and supplier members. In addition to celebrating Jim’s legacy, we are going to continue it. We announced the promotions of Terry Arth to senior vice president of member services and conferences; Steve : to senior vice president of industry affairs and member relations; Marilyn Hunter to vice president of meetings and conferences; and Stephanie Bennett to vice president of executive and board relations. There is more than a century of combined NACDS leadership and experience in those promotions. That is what I call a succession plan.
