PBM Reform Bill Signed, Heralding New Era for Patient Care Access

WASHINGTON, D.C. – February 03, 2026 – President Trump today signed into law a landmark government funding bill that includes the most significant federal reforms to the pharmacy benefit manager (PBM) industry to date, a move celebrated by patient advocates and pharmacy providers as a historic victory for Americans with complex medical conditions.

The new legislation is designed to curb long-criticized practices by PBMs—the powerful middlemen who manage prescription drug benefits for health plans—that have been accused of restricting patient access and financially squeezing specialty pharmacies. These pharmacies are crucial providers of life-sustaining medications for conditions like cancer, multiple sclerosis, and rare genetic disorders.

The National Association of Specialty Pharmacy (NASP) lauded the bill's passage and signing, framing it as a long-awaited course correction. “Today, Congress and the Trump Administration delivered a historic victory for patients who rely on complex specialty therapies—and for the specialty pharmacies that ensure those treatments are delivered safely and effectively,” said Sheila Arquette, President and CEO of NASP, in a statement. “This landmark federal action represents the most significant step yet toward ending those practices.”

A Lifeline for Patients with Complex Conditions

For millions of Americans battling serious illnesses, a specialty pharmacy is far more than just a place to pick up a prescription. These providers offer a high-touch care model that includes extensive patient education, coordination with doctors, adherence monitoring, and management of complex side effects associated with powerful medications. This integrated support is vital for keeping patients on their treatment regimens and out of the hospital.

However, in recent years, many patients have found their access to these trusted providers severed by the restrictive networks imposed by PBMs. These networks often force patients to use a specific, PBM-affiliated mail-order pharmacy, disrupting established relationships with care teams who have deep knowledge of their medical history and needs. Patient advocacy groups have long argued that this practice prioritizes PBM profits over patient well-being and continuity of care.

The new law directly confronts this issue by placing limits on PBMs' ability to exclude qualified and accredited specialty pharmacies from their networks. The provisions are expected to foster broader “any willing provider” standards, ensuring that patient choice is protected. For patients, this means they are less likely to be forced to switch pharmacies mid-treatment, a change that advocates say will reduce medication errors, improve adherence, and ultimately lead to better health outcomes.

Reforming the Gatekeepers of a Shadowy System

The legislation strikes at the heart of the financial and operational models that have allowed PBMs to flourish while drawing intense scrutiny. Three key areas of reform are central to the new law: reimbursement, transparency, and network composition.

First, the bill tackles the issue of “underwater reimbursement,” a practice where PBMs pay pharmacies less than their acquisition cost for a drug. This has pushed many independent specialty pharmacies to the brink of financial collapse, forcing them to choose between taking a loss on a prescription or not stocking a critical medication at all. The new law is expected to mandate reimbursement at or above the pharmacy's actual cost, plus a fair, professional dispensing fee, thereby ensuring their financial viability.

Second, it targets the “opaque practices” that have defined the PBM industry. The law will require unprecedented transparency, forcing PBMs to disclose the complex web of rebates, fees, and discounts they negotiate with drug manufacturers. It also aims to eliminate “spread pricing,” a controversial practice where a PBM charges a health plan a higher price for a drug than it reimburses the pharmacy, pocketing the difference as pure profit without the knowledge of the plan sponsor.

“For too long, specialty pharmacies have faced underwater reimbursement, opaque practices, and restrictive networks that have forced many qualified providers out of network and disrupted continuity of care for some of the sickest patients in America,” Arquette noted.

These reforms are poised to dramatically shift the economic landscape. While specialty pharmacies are expected to gain stability and a fairer competitive footing, PBMs will face significant pressure to adapt. Their business models, long reliant on financial arbitrage within the drug supply chain, must now evolve towards demonstrating value through transparent services and clinical management.

A Bipartisan Breakthrough on Healthcare Costs

The passage of PBM reform is a testament to a rare and growing bipartisan consensus in a deeply divided Washington. Over the past several years, lawmakers from both parties have increasingly targeted PBMs as a key driver of rising prescription drug costs and a source of frustration for constituents, from patients to small-business pharmacy owners.

Congressional committees like the Senate Finance Committee and the House Energy and Commerce Committee held numerous hearings, building a substantial public record of the negative impacts of PBM practices. This legislative groundwork, combined with a powerful coalition of patient advocacy groups, physician associations, and pharmacy organizations, created overwhelming political momentum that proved difficult to resist.

The bill’s success demonstrates a shared political will to bring accountability to a notoriously complex and powerful sector of the healthcare industry. By focusing on the common ground of transparency and fair market practices, lawmakers were able to forge a compromise that could serve as a model for tackling other contentious healthcare issues.

Scott Guisinger, NASP's Chairman of the Board, highlighted this collaborative spirit. “By increasing transparency and curbing anti-competitive practices, the bipartisan reforms passed today will help ensure that specialty patients can continue working with the pharmacists and care teams who understand their conditions, treatment regimens, and clinical risks,” he stated.

The Road Ahead: Implementation and Industry Response

With the bill now signed into law, the focus immediately shifts to implementation. Federal agencies will be tasked with writing the specific rules and regulations that will govern how these reforms are put into practice, a process that will be closely watched by all stakeholders.

“Our focus now turns to swift and thoughtful implementation to ensure that Congress’s intent—to protect patient access to high-quality specialty pharmacy services—is fully realized in practice,” Arquette confirmed, signaling that the fight for patients and pharmacies is entering a new phase.

The PBM industry is not expected to remain idle. While publicly committing to compliance, major PBMs and their trade associations are likely to explore legal challenges to the new rules and will undoubtedly lobby heavily to influence the regulatory process in their favor. The legislation likely includes a phased rollout, with transparency requirements taking effect sooner than the more complex reimbursement and network reforms, giving the industry time to adjust its operations.

For now, however, patients and their pharmacy providers are celebrating a watershed moment. The new law represents a fundamental shift in power, re-centering the prescription drug system on the principles of patient access and fair competition, though the true test of its success will unfold in the months and years to come as the reforms take hold.