APhA‑backed reforms pass Congress--Covering pharmacist care must be next

WASHINGTON, Feb. 3, 2026 /PRNewswire/ -- Today, Congress passed funding legislation that includes long-sought federal PBM reforms, supported by the American Pharmacists Association (APhA), which are set to be signed into law. These provisions mark meaningful progress toward strengthening pharmacy reimbursement in Medicare and will help pharmacies sustainably dispense medications. However, APhA has long contended that any reforms to the pharmaceutical payment system must be coupled with coverage of pharmacists' care services through legislation such as H.R. 3160, the Ensuring Community Access to Pharmacist Services Act. APhA is disappointed Congress failed to include this legislation.

Pharmacists nationwide have highlighted the need for greater clarity and predictability in reimbursement and contracting arrangements to support patient access and the long-term viability of community pharmacies. These reforms signal steady progress toward a modernized payment system that not only recognizes the essential role pharmacists play in medication dispensing but also sets the stage for increased delivery of pharmacist-provided preventive and clinical services that improve patient outcomes and reduce overall Medicare costs.

"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," said Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP, executive vice president and CEO of APhA. "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."

"Pharmacist-delivered care reduces overall health care costs, prevents avoidable hospitalizations, and supports healthier communities nationwide. These reforms are an important first step, and lasting progress requires valuing pharmacists not only as dispensers of medications, but as front-line primary health care providers."

Key provisions include:

• Pharmacy fairness and access in Medicare Part D — CMS must define and enforce reasonable, relevant, and transparent Part D contract terms for pharmacies, including information about reimbursement and dispensing fees, with a request for information on April 1, 2027; standards by 2028; and, implementation on January 1, 2029, as well as protections ensuring that any willing pharmacy that meets the terms and conditions may participate as a network pharmacy.
• Delinking PBM compensation from drug list prices in Medicare plans — Beginning January 1, 2028, PBMs will transition from price-based compensation to service-based payments, promoting greater transparency and alignment across Medicare drug plans.
• Ongoing oversight — Congress has also directed the Government Accountability Office and the Medicare Payment Advisory Commission to produce formal reports evaluating PBM arrangements across the supply chain and within Prescription Drug Plans and Medicare Advantage–Prescription Drug (MA PD) plans, including how these agreements affect both pharmacy reimbursement and beneficiary out-of-pocket spending.

"Congress has taken an important first step toward a more balanced and supportive payment environment for our nation's community pharmacists. APhA will continue working with Congress, federal agencies, and health care stakeholders to ensure pharmacists are fully recognized and fairly compensated for the comprehensive health care services patients rely on every day," Hogue concluded.

About APhA
Founded in 1852, APhA is the only organization advancing the entire pharmacy profession. From our headquarters in Washington, DC, APhA leads the pharmacy profession by supporting pharmacists, student pharmacists, and pharmacy technicians in their role optimizing medication use and patient health outcomes and ensuring patients have access to pharmacists' care. We do this through our strong and effective advocacy, top notch education, practice tools and resources, dissemination of evidence, and opportunities for members to engage and learn from each other. APhA is the pharmacy voice at the table in developing national guidelines, policies, and best practices that advance the profession and patient care.

To learn more, visit www.pharmacist.com.

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SOURCE American Pharmacists Association