What PBM reform proposals would change for pharmacies
Pharmacy benefit managers sit between drug manufacturers, health plans and pharmacies. Reform proposals target how PBMs are paid, how they reimburse pharmacies and what they must disclose. Here is what is already in force and what is only proposed.
The signal
PBMs manage prescription drug benefits for insurers, Medicare Part D plans and employers. Reform proposals target spread pricing, how PBMs are compensated and what they must disclose; for Part D pharmacies, price concessions have been applied at the point of sale since January 1, 2024.
Why this matters
PBM contract terms shape what pharmacies are paid, which pharmacies patients can use and what patients pay at the counter. Rules that change how PBMs operate — enacted or proposed — can change pharmacy cash flow and patient costs.
NPHLA takeaway
Separate what is in force from what is proposed. Point-of-sale price concessions in Part D already apply; other reforms depend on legislation and rulemaking that are still moving. Review PBM contracts against the rules that actually apply in your state. General information, not legal or financial advice.
Source file
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Drafted with AI assistance from the sources listed in the Source File, then reviewed and approved by an NPHLA editor before publication. NPHLA links to sources and does not republish their text. Professional information only — not medical, legal or regulatory advice for any individual situation. Our standards.