• Arkansas Law Bans State Permits to PBM-owned Pharmacies Effective 2026 
• 39 State and Territory Attorneys General Urge Passage of Federal PBM Reform Legislation
• NCPA Reacts to Trump’s New Drug Pricing Executive Order
• Tariffs Must Be Finely Tuned to Avoid Higher Costs to Pharmacies
• Urge Your Congressman to Sign onto a Letter Calling to Course Correction on CMS’ Implementation of Medicare Prescription Drug Price Negotiation Program
• Alabama Governor Signs PBM Reform Bill into Law
• 2025 NCPA Congressional Pharmacy Fly-in Less Than Two Weeks Away
• ESI Audit by Tennessee DCI Shocks
• Ohio Shows PBM and Medicaid Reforms Save Money
• NCPA State Legislative Activity Update

Arkansas Law Bans State Permits to PBM-owned Pharmacies Effective 2026

This week, Gov. Sarah Huckabee Sanders (R) signed into law a groundbreaking bill, H.B. 1150, to prohibit state permits to pharmacies owned by pharmacy benefit managers effective Jan. 1, 2026. In a statement, NCPA said prohibiting PBM ownership of pharmacies will help put an end to anticompetitive tactics like patient steering, below-cost reimbursements, and punitive audit practices, all while promoting Arkansans' access to quality pharmacy care. 

Congratulations to the Arkansas Pharmacists Association on this innovative legislative win. NCPA supported the APA's leadership on H.B. 1150 as it moved through the legislative process.

39 State and Territory Attorneys General Urge Passage of Federal PBM Reform Legislation

This week, the National Association of Attorneys General sent, on behalf of a bipartisan coalition of 39 state and territory attorneys general, a letter urging congressional leadership to pass "an act prohibiting PBMs, their parent companies, or affiliates from owning or operating pharmacies."

In the letter the attorneys general state that PBMs use their intermediary role to disadvantage independent pharmacies, forcing them to accept confusing, unfair, arbitrary, and harmful contractual terms. Further, it states that PBMs have used vertical integration with pharmacies, insurance companies, and others to "control every step of the prescription, manufacturing, wholesale, retail, and dispensing process."

"The control of the pharmaceutical ecosystem by PBMs has resulted in decreased access, affordability, and choice for many Americans seeking prescription healthcare. Congressional action is warranted to restore a free market and protect consumers and small businesses," the attorneys general wrote.

You can read the letter here.

NCPA Reacts to Trump’s New Drug Pricing Executive Order

Earlier this week, President Trump signed an executive order that aims to lower drug prices and includes provisions to reevaluate the role of middlemen in the supply chain and improve the transparency of pharmacy benefit managers. In a statement, NCPA said that while the devil will be in the details and the implementation, we are "optimistic that the administration is making moves to address PBMs. President Trump has talked several times about the need to rein them in, and we're pleased he's looking to do so." To read the executive order, click here. To read a fact sheet about the president's action, click here. 

Tariffs Must Be Finely Tuned to Avoid Higher Costs to Pharmacies

President Trump this week indicated again that tariffs on pharmaceuticals will be coming, and the Department of Commerce announced a study on pharmaceuticals that most observers believe is a precursor to something more concrete. 

NCPA supports the effort to bring pharmaceutical manufacturing back to the United States. Our experience during COVID reminded everyone how dangerous it is to rely on foreign suppliers, especially hostile countries, for critical medicines and medical supplies. However, we are also extremely concerned that tariffs on pharmaceuticals could trigger shortages in the near term and, just as dangerous, force independent pharmacies to absorb higher costs. In the coming weeks we'll be making that point crystal clear to the administration. 

They must understand that independent pharmacies are the last link in the supply chain. The manufacturers certainly will pass on the tariffs. And it's as predictable as the tides that increased drug prices will be passed on to pharmacies. Unless the federal government ensures that PBM pharmacy reimbursements are increased to reflect higher costs, the ripple effect of tariffs could be fewer pharmacies, stranded patients, and inadequate pharmacy networks for Medicare and Medicaid.

In the president's recent executive order on drug prices, he called out PBMs directly, ordering various agencies to reconsider their role in the health care industry and rein in their anticompetitive practices. So, he and his team are clearly aware of their abuses. Our goal now is to make sure they see the potential for more abuses if their tariff policy isn't carefully written. 

Urge Your Congressman to Sign onto a Letter Calling to Course Correction on CMS’ Implementation of Medicare Prescription Drug Price Negotiation Program

Please take a moment and urge your Representative to sign onto a bipartisan letter being led by Reps. Buddy Carter (R-Ga.) and Jacke Auchincloss (D-Mass.) to CMS urging a course correction on how the Medicare Drug Price Negotiation is being implemented. As it stands, CMS is requiring pharmacies to financially float the program as they are required to purchase covered drugs at the wholesale price while only being reimbursed the maximum fair price by plans and waiting several weeks for the manufacturers to make them whole. Pharmacies are already unfairly squeezed by PBMs and cannot afford to float the program. 

Alabama Governor Signs PBM Reform Bill into Law

In a momentous win, Alabama Gov. Kay Ivey (R) signed S.B. 252, the Community Pharmacy Relief Act, into law this week. The law ties commercial reimbursement for independent pharmacies to the state’s Medicaid reimbursement methodology, which uses a state-based average acquisition cost benchmark plus a professional dispensing fee of $10.64. The bill has strong enforcement provisions for the Department of Insurance, prohibits spread pricing, curtails patient steering, and addresses the role of PBM affiliates and third parties, such as discount cards. 

S.B. 252 was the result of combining two bills, one introduced by Alabama Pharmacy Association and the other by the Alabama Independent Pharmacy Alliance. It is also an amazing comeback story after a hard-fought battle last year that came up short. NCPA salutes all stakeholders for their passion, dedication, and resilience!

2025 NCPA Congressional Pharmacy Fly-in Less Than Two Weeks Away

NCPA’s 2025 Congressional Pharmacy Fy-in is less than two weeks away. If you have not registered, don’t delay as it is nearing capacity as determined by the fire marshal. Don’t miss your opportunity to hear remarks from Rep. Rep. Buddy Carter (R-Ga.), chairman of the Energy and Commerce Health Subcommittee and a key ally of NCPA in Congress and a pharmacist himself. We will also have panels featuring majority and minority staff from the Senate Finance Committee and NCPA’s outside lobbying firm, Capitol Counsel. 

Fly-in is a fantastic chance to deepen your existing relationships with policymakers and get a foot in the door with the dozens of new members of Congress. We need your help to make it clear how much our communities need access to independent pharmacy care. Register here. 

ESI Audit by Tennessee DCI Shocks

The Tennessee Department of Commerce and Insurance published its audit of Express Scripts for activity in 2023 and found many areas of noncompliance that harmed community pharmacies. Among the many disturbing findings, none of the 116 randomly selected claims to low-volume pharmacies received the enhanced dispensing fee as required. The audit found many egregious examples of ESI reimbursing its owned or affiliated pharmacies at much higher rates than those not owned or affiliated with ESI, also contrary to law. 

ESI was shown to be non-compliant in nearly every aspect of the state's appeals process, including providing required information and meeting timelines. Initial reimbursement appeals were denied 83 percent of the time by ESI, but when the claims were submitted to the state for external review, 85 percent of those claims were overturned and paid more by an average of $60.29 or 64 percent.

These audits are the result of authorities granted to the department via H.B. 2661 in 2022 and then implemented with robust rulemaking by the department in 2023. ESI was one of five PBMs audited by the department in 2024.

The Tennessee Pharmacists Association issued a call to action in response to the audit findings, urging policymakers and legislators in Tennessee and Congress to strengthen and enforce PBM reform legislation. It also said employers and health plan sponsors should critically evaluate the value offered by PBMs and ensure the value is delivered.

Ohio Shows PBM and Medicaid Reforms Save Money

The Ohio Department of Medicaid published a report evaluating the Single PBM reform program mandated by H.B. 166 from 2019 and implemented on Oct. 1, 2022. Single PBM programs look to enhance cost efficiency, improve medication adherence, and provide more coordinated care in Managed Medicaid programs. For Ohio pharmacies, this also entailed reimbursement using the state Medicaid program’s fee-for-service reimbursement methodology.  The report found a total savings of $140 million during the first two years of the Single PBM program, even after the average professional dispensing fee shifted from $0.73 to around $9 per the fee-for-service methodology. 

The report found these changes stabilized the Medicaid marketplace, preserving and even expanding patient access. Citing Board of Pharmacy data, more Medicaid pharmacy locations were added during the two years than any time since 2012. The report demonstrates that PBM and Medicaid reforms using transparent cost-based reimbursement models such as NADAC plus a professional dispensing fee don’t increase costs; in fact they can save money for employers, insurers, and taxpayers.

NCPA State Legislative Activity Update

NCPA tracks state legislation related to our top three state priorities: Medicaid reform, scope of practice and compensation for services, and PBM reform and regulation. Click each issue for a report of bills that have been introduced so far this session specifically dealing with these three issue areas. You can access the individual bill language and basic information on the bill by clicking on the bill numbers in the attached report. Bills that have moved this week are listed at the top in the “Recently Updated” section. 

NCPA’s Advocacy Center Update provides a weekly detailed summary of recent and breaking legislative, regulatory, and state developments impacting independent community pharmacy and NCPA’s efforts to affect policies benefitting its membership and the industry. The weekly update is distributed to NCPA leadership, steering committees, allied organizations/stakeholders, and major contributors to the NCPA LDF and PAC. The weekly update is intended exclusively for the recipient and is not for external distribution.