Congress Passes PBM Reforms Backed by APhA, but Pharmacist Care Coverage Left Out
Event summary
- Congress passed PBM reforms supported by APhA, set to be signed into law.
- Key provisions include Medicare Part D pharmacy fairness standards by 2028 and PBM compensation delinked from drug list prices by 2028.
- APhA expresses disappointment that Congress did not include coverage for pharmacist care services in H.R. 3160.
- CMS must define and enforce transparent Part D contract terms for pharmacies by 2029.
- Ongoing oversight includes GAO and MedPAC reports on PBM arrangements.
The big picture
The passage of PBM reforms marks a significant step toward modernizing pharmacy reimbursement in Medicare, addressing long-standing issues of transparency and predictability. However, the exclusion of pharmacist care coverage highlights a strategic gap in healthcare delivery, as pharmacists play a critical role in preventive and clinical services that reduce overall costs. The reforms set the stage for increased pharmacist-provided services, but lasting progress hinges on recognizing and compensating pharmacists as front-line primary healthcare providers.
What we're watching
- Regulatory Implementation
- The pace at which CMS defines and enforces transparent Part D contract terms by 2029.
- Pharmacist Advocacy
- Whether APhA can push Congress to include pharmacist care coverage in future legislation.
- PBM Transition
- How the shift from price-based to service-based PBM compensation affects Medicare drug plans.