President Donald Trump signed landmark legislation into law on February 3, 2026, aiming to rein in the power of pharmacy benefit managers (PBMs) and lower prescription drug costs. The reforms, codified as part of HR 7148, the Consolidated Appropriations Act of 2026, build upon the PBM Reform Act of 2025 and are expected to increase transparency and access within Medicare and Medicaid.1-4
“The abuses of the dominant PBM middlemen are widely recognized, and this landmark federal action reflects the broad, bipartisan commitment to confront and remedy them,” said Steven C. Anderson, president and CEO of the National Association of Chain Drug Stores (NACDS). “This is the most important federal achievement yet for PBM reform, and it will sustain and build momentum for further reforms where needed.”5
What’s in the New PBM Legislation?
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The Consolidated Appropriations Act incorporates key provisions from Representative Earl L. “Buddy” Carter’s (R–GA) PBM Reform Act of 2025, aiming to overhaul how prescription drugs are priced and distributed.6
Increased Transparency for Health Plans
PBMs will now be required to submit detailed, semi-annual reports to employer plans, outlining net drug spending, rebates, and “spread pricing” practices. These reports must also explain how plan designs might steer patients toward PBM-affiliated pharmacies. Summary documents will be made available to plan participants and beneficiaries, ensuring they understand drug spending and coverage details.6
PBM Accountability in Medicare Part D
Starting in 2028, PBMs and their affiliates will be barred from receiving remuneration for Part D services beyond “bona fide service fees.” These fees must be flat dollar amounts tied to genuinely performed services at fair market value.6
PBMs will also need to provide more comprehensive annual reports to Part D plan sponsors, detailing manufacturer revenue, total gross spending, and average pharmacy reimbursement rates. Plan sponsors will gain the right to audit PBMs annually to verify compliance and data accuracy.6
“Any Willing Pharmacy” Protections
Beginning in 2029, Part D sponsors must allow any pharmacy meeting standard contract terms to participate in their networks—a policy known as any willing pharmacy. The Department of Health and Human Services (HHS) will establish standards for “reasonable and relevant” contract terms by April 2028.6
The bill establishes a new category of “essential retail pharmacies,” including those in rural, underserved, or urban areas with limited access. HHS will publish a list of these pharmacies and track their network participation and reimbursement rates.6
Pharmacies will have a formal process to report PBM contract violations, and Part D sponsors are prohibited from retaliating against pharmacies that raise concerns, with penalties for non-compliance.6
What Do These Changes Mean for Pharmacists?
These reforms aim to shift power from PBMs to individual pharmacies, increasing reimbursement transparency. The American Pharmacists Association (APhA), which supported the legislation, believes pharmacists will have stronger Medicare reimbursement options and be able to sustainably dispense medications.7
Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP, executive vice president and CEO of APhA, stated that the reforms signal progress toward a modernized payment system recognizing the vital role of pharmacists. He added that this could lead to expanded pharmacist-led clinical and preventive services, potentially reducing Medicare costs and improving patient outcomes.7
However, Hogue and APhA emphasize that these reforms should be coupled with legislation recognizing and covering pharmacist-provided care services through Medicare. Specifically, HR 3164, the Ensuring Community Access to Pharmacist Services Act, was not included in the Consolidated Appropriations Act of 2026; its passage would ensure consistent, covered access to essential services like testing, treatment, and vaccinations.7,8
“While these reforms begin to address one of the most significant challenges pharmacists face under Medicare, they represent one part of the broader effort needed to strengthen pharmacy access and fully support patient care,” Hogue said. “To truly improve health care delivery, Congress and Medicare must also now recognize and pay for the patient care services that pharmacists provide every day.”7
The full impact of this legislation on patients remains to be seen. Pharmacists should stay informed about changes to PBM practices and adjust their workflows accordingly.
