Pill bottle with pills overlaying goveernment building
Buchanan – Online Article – February 12, 2026
On February 3, 2026, Congress passed the Consolidated Appropriations Act, 2026, a major step toward reforming pharmacy benefit manager (PBM) practices. The legislation includes United States House Bill 7148, which introduces new rules designed to increase transparency, accountability, and fairness in the prescription drug supply chain.
For years, PBMs have played a central role in drug pricing and pharmacy networks. However, critics have argued that rebate-driven incentives and limited transparency have contributed to higher drug costs and restricted access for independent pharmacies. As a result, lawmakers moved to implement reforms that strengthen oversight and expand pharmacy access.
First, the new law introduces a federal “Any Willing Pharmacy” provision. Beginning in 2028, prescription drug plans must allow any pharmacy that meets standard contract terms to participate in their networks.
As a result, independent and community pharmacies will have greater opportunities to serve patients without facing exclusion from preferred networks. In addition, the law creates a new category of essential retail pharmacies, recognizing pharmacies located in rural or underserved areas.
The U.S. Department of Health and Human Services will publish a list of these pharmacies and monitor reimbursement trends. Consequently, policymakers will gain better insight into how pharmacies serving vulnerable populations are treated within PBM networks.
Next, the legislation changes how PBMs are paid in Medicare Part D plans.
Starting in 2028, PBMs will be compensated only through flat service fees that reflect fair market value. Previously, PBM compensation was often linked to rebates negotiated with drug manufacturers. Because those rebates were frequently tied to drug list prices, critics argued that the system could encourage higher-priced medications.
By shifting to fixed service fees, lawmakers hope to reduce those incentives and promote more cost-effective drug pricing.
Equally important, the law introduces stronger transparency requirements. PBMs must now provide employer health plans with semiannual reports detailing net drug spending, rebates, and spread pricing arrangements.
Furthermore, pharmacies now have a formal process to report PBM contract violations, along with protections against retaliation.
In addition, prescription drug plan sponsors gain enhanced audit rights. At least once per year, PBMs must allow comprehensive audits of their records, contracts, and data. This requirement ensures that plan sponsors can verify compliance and confirm the accuracy of PBM reporting.
Overall, the 2026 PBM reform law represents one of the most significant federal actions targeting PBM practices. While some provisions are already in effect, others will roll out gradually through 2028.
Ultimately, the reforms aim to create a pharmacy benefit system that is more transparent, competitive, and patient-focused. For patients, employers, and independent pharmacies, the changes signal a shift toward greater choice, fairness, and accountability in the prescription drug marketplace.
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