PBM Reforms Take Effect, Independent Pharmacies Gain New Protections

The most significant federal pharmacy benefit manager (PBM) reform in decades went into effect this year, fundamentally reshaping PBM operations under Medicare Part D. The changes, enacted by Congress in 2026, aim to level the playing field for independent pharmacies and lower costs for taxpayers, following negotiations that stalled in late 2024.

A key component of the reform establishes “any willing pharmacy” requirements, granting independent pharmacies new protections against arbitrary network exclusions by PBMs. This provision is intended to ensure that pharmacies meeting standard credentialing criteria can participate in PBM networks, increasing patient access and fostering competition.

The National Community Pharmacists Association (NCPA) has been a leading advocate for PBM reform, highlighting the demand for transparency and fair practices within the pharmaceutical supply chain. According to the NCPA, the initial PBM reform provisions—which ultimately did not pass in the December 2024 Consolidated Appropriations Act—would have generated $5 billion in taxpayer savings.

While the “any willing pharmacy” provisions are immediately in effect, further financial impacts are slated for the coming years. PBMs will be prohibited from profiting from drug pricing or utilizing spread pricing—the practice of retaining the difference between the amount billed to health plans and the amount reimbursed to pharmacies—beginning in 2028. This measure is designed to eliminate financial incentives that contribute to inflated drug costs.

Anne Cassity of the NCPA described the passage of the federal PBM reform as a “historic” moment for community pharmacies. The new Medicare Part D contracting standards are expected to reshape reimbursement and oversight, potentially stabilizing the financial viability of independent pharmacies.

Despite the enacted reforms, ongoing advocacy efforts focus on further strengthening pharmacy payment models. The NCPA continues to push for comprehensive payment reform to ensure pharmacies are fairly compensated for the services they provide.

As of February 18, 2026, the NCPA is actively monitoring implementation of the new PBM rules and preparing for the 2028 restrictions on PBM profit models. The organization has not yet issued a statement regarding potential legal challenges to the implementation of the reforms.