• House Energy and Commerce Passes Health Section of Budget Which Includes NCPA Priority
• UHG is Being Investigated for Possible Medicare Advantage Fraud
• NCPA’s Stance on Drug Pricing Executive Order
• CMS Finalizes Medicare Advantage and Part D Payment, Policy Updates
• Senate Judiciary Committee Keeps up the Pressure on PBMs in Lively Hearing
• Montana Continues Streak of State Laws Supporting Independent Pharmacies
• Kemp Bolsters State Employee Plans with Fair Reimbursement
• NCPA Submits Comments on Deregulation to OMB
• NCPA State Legislative Activity Update

House Energy and Commerce Passes Health Section of Budget Which Includes NCPA Priority

The House Committee on Energy and Commerce passed a portion of the budget reconciliation bill that includes legislation introduced by Health Subcommittee Chairman Buddy Carter (R-Ga.) to eliminate spread pricing and require transparent and fair reimbursement (Medicaid fee-for-service-rate) in all state Medicaid managed care programs. The House Budget Committee is set to meet to combine all the different sections reported out from their respective committees' jurisdictions, with a final floor vote expected to be next week. After that, the legislation will head to the Senate for further consideration. 

UHG is Being Investigated for Possible Medicare Advantage Fraud

The Department of Justice is investigating UnitedHealth Group for possible Medicare Advantage-related fraud, the Wall Street Journal reported last week. The investigation has been active since at least last summer and is run by the DOJ’s criminal health care fraud unit, according to the story.

UHG is also facing DOJ investigations over potential antitrust violations and a civil investigation of its Medicare billing practices, the newspaper noted.

In his confirmation hearing, Centers for Medicare & Medicaid Services Administrator Mehmet Oz pledged to senators that he would crack down on insurers’ attempts to inappropriately boost the Medicare Advantage payments they receive.

WSJ subscribers can read the article here.

NCPA’s Stance on Drug Pricing Executive Order

President Donald Trump signed an executive order Monday to slash drug prices by reviving Most Favored Nation drug pricing. In a statement, NCPA CEO Douglas Hoey said in part, “We need to get more details on the president’s executive order as this will take time to sort out due to the complicated nature of drug pricing in this country. However, we applaud any efforts to rein in pharmacy benefit manager practices that increase drug costs. We urge President Trump to continue to focus on PBM middlemen and the way they artificially inflate the price of prescription drugs to pad their pockets.” 

You can read our full statement here.

CMS Finalizes Medicare Advantage and Part D Payment, Policy Updates

CMS recently finalized key payment and policy updates for the Medicare Advantage and Part D programs for 2026, aiming to strengthen beneficiary protections, improve drug price transparency, and advance health equity. Medicare Advantage plan payments will increase by 5.06 percent from 2025 to 2026, which is higher than expected. CMS attributed this increase to a higher effective growth rate than estimated in the CY 2026 Advance Notice. 

In the same comment period, CMS also asked for feedback on how to simplify and refocus the measure set used in Part C and Part D Star Ratings. During this open comment period, NCPA asked that if the measure of comprehensive medication review completion was retired from the medication therapy management program, that the program implement other methods to modernize the program and recognize pharmacists' clinical impact.

CMS acknowledged these comments in their announcement and said they will be considered as it proposes future changes to the measures. All substantive measure specification changes, the addition of new measures, and methodological changes must go through the rulemaking process. Read NCPA's full comments here. 

Senate Judiciary Committee Keeps up the Pressure on PBMs in Lively Hearing

Both Democrats and Republicans were critical of pharmacy benefit managers in a May 13 hearing of the Senate Judiciary Committee titled “PBM Power Play: Examining Competition Issues in the Prescription Drug Supply Chain.” Senators from both parties raised concerns about the concentrated market control of the “Big Three” PBMs, which now dominate 80 percent of the prescription drug market and remain vertically integrated, contributing to high drug costs and limiting patient access. Several witnesses testified to the harmful effects of PBM practices, particularly on independent pharmacies. 

Chairman Chuck Grassley (R-Iowa) and Ranking Member Dick Durbin (D-Ill.) both called out how PBMs are harming local pharmacies and the need for legislation on this bipartisan issue. Tensions rose during the hearing, with Sen. Josh Hawley (R-Mo.) pressing the PBM industry on accountability and conflict of interest. Sen. Thom Tillis (R-N.C.) called out the need for audits in the Tricare pharmacy contract. Sen. Marsha Blackburn (R-Tenn.) cited examples of discriminatory reimbursement rates favoring PBM-owned pharmacies. The meeting concluded with Sen. Cory Booker (D-N.J.) calling for bipartisan action. NCPA is submitting a statement for the record for this hearing and is encouraged by the continued bipartisan support for PBM reform. 

Montana Continues Streak of State Laws Supporting Independent Pharmacies 

Gov. Greg Gianforte (R) signed into law H.B. 740, PBM legislation that includes a requirement that independent pharmacies be reimbursed in the commercial market at the rate of NADAC plus a professional dispensing fee of $15. The law also requires the professional dispensing fee to be increased every January 1 to reflect changes to the consumer price index. Another key provision prohibits direct or indirect payment reductions via effective rate contract terms

NCPA was pleased to support stakeholders with consultation, comment letters, social media support, and a grassroots call to action. The legislation takes effect Oct. 1, 2025, and has a sunset provision of June 30, 2029.

Gov. Kemp Bolsters State Employee Plans with Fair Reimbursement

After vetoing similar legislation last year, Gov. Brian Kemp (R) signed into law HB 196, creating a pharmacy reimbursement floor in state health plans serving state employees, teachers and other public school employees, and current and retired employees of the University System of Georgia.  The floor uses NADAC plus a professional dispensing fee of $11.50 for independent pharmacies and $10.50 for chain pharmacies.  The bill also wisely closes discount card loopholes that PBMs often use to avoid regulation.  NCPA congratulates the Georgia Pharmacy Association and other stakeholders for not giving up after last year’s surprise veto and getting the bill back on the Governor’s desk for reconsideration. 

NCPA Submits Comments on Deregulation to OMB

NCPA submitted comments to the Office of Management and Budget on its request for information on deregulation. The agency asked that respondents identify any regulation they think should be rescinded and provide detailed reasons for doing so. In our comments, NCPA called for:

- Reforming the Inflation Reduction Act’s Medicare Drug Price Negotiation Program.

- Striking the requirement that CMS mandate participation in the MDPNP via PBM/plan contracts;

- Striking various regulations regarding compounding;

- Modifying the Nonprescription Drug Products with Additional Conditions for Nonprescription Use (ACNU) final rule to standardize the ACNU process and incorporate the role of the pharmacist;

- Modifying overly burdensome regulations that currently ban qualified prescribers from prescribing methadone for opioid use disorder and pharmacies from administering/dispensing it pursuant to a prescription;

- Striking the positive ID requirements requiring that pharmacists verify identification of the patient when filling prescriptions for Schedule III-V medications for the treatment of opioid use disorder that were issued on the basis of a telemedicine encounter; and

- Striking an interpretive ruling and fact sheet regarding country of origin (COO) markings for prescription medication bottles that pharmacies dispense to patients indicating that medication bottles pharmacies dispense to patients must be marked with the COO on the packaging that the patient receives.

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.