• Bipartisan Group of Legislators Introduce Comprehensive PBM Reform Bill in the House
• CMS Head Clarifies Pharmacies Don’t Need to Actually Dispense Drugs Under MDPNP
• Webinar on Medicare Transaction Facilitator Enrollment
• Host Your Legislator for a Pharmacy Visit and Demand Action on PBM Reform
• NCPA Joins Other Pharmacy Organizations in Urging Insurers to Maintain Vaccine Coverage
• Strong PBM Reforms Enacted in North Carolina
• Pharmacy Taxes Defeated
• Ex-PCMA President Calls for Reining in Middlemen
• Reimbursement Round Up 

Bipartisan Group of Legislators Introduce Comprehensive PBM Reform Bill in the House

This week, Reps. Buddy Carter (R-Ga.), Debbie Dingell (D-Mich.), Greg Murphy (R-N.C.), Deborah Ross (D-N.C.), Jodey Arrington (R-Texas), Diana Harshbarger (R-Tenn.), Vicente Gonzalez (D-Texas), Rick Allen (R-Ga.), Raja Krishnamoorthi (D-Ill.), John Rose (R-Tenn.), Derek Tran (D-Calif.),  and Nicole Malliotakis (R-N.Y.). introduced the PBM Reform Act. This legislation includes all the PBM reforms that were received bipartisan, bicameral agreement in December, but were not passed. Included, are NCPA priorities that would require all Medicaid managed care programs to reimburse pharmacies at NADAC plus the state’s fee for service dispensing fee and require CMS to define and enforce reasonable and relevant contract terms in Medicare Part D, including those related to reimbursements. NCPA called for swift passage of this legislation. Read NCPA’s press release here and voice your support for the bill here. 

CMS Head Clarifies Pharmacies Don’t Need to Actually Dispense Drugs Under MDPNP

Centers for Medicare & Medicaid Services Administrator Mehmet Oz sent a letter to Rep. Buddy Carter (R-Ga.) clarifying that pharmacies do not need to actually dispense drugs under the Medicare Drug Price Negotiation Program (MDPNP). Specifically, Oz stated that "Enrolling in and using the MTF [Medicare Transaction Facilitator] is free for pharmacies and does not place any requirement on them to actually dispense selected drugs under the Part D program."

Additionally, CMS' Medicare Part D final rule from April 2025 says PBMs must put contractual language in place obligating pharmacies to participate in the MDPNP if they participate in any Part D network. Based on the letter from Oz, it appears that the rule requires pharmacies to enroll in the MTF but does not require them to actually dispense drugs covered by the MDPNP. 

NCPA will keep its members posted on any developments. For resources on the MDPNP, click here.

Webinar on Medicare Transaction Facilitator Enrollment

By now, you've probably heard that to participate in any Medicare Part D network in 2026 and future years, you must enroll in the Medicare Transaction Facilitator Data Module of the Medicare Drug Price Negotiation Program. Join us July 31 as we explain the MTF enrollment process and answer any questions NCPA members have about it. Register here.

Host Your Legislator for a Pharmacy Visit and Demand Action on PBM Reform

With PBM reforms falling out of the budget reconciliation bill, and the introduction this week of the PBM Reform Act, we need to continue pressing Congress to include previously agreed upon reforms—particularly those that enhance transparency and ban spread pricing in Medicaid managed care programs and require CMS to define and enforce reasonable and relevant contract terms, including those related to reimbursements, in Medicare Part D—in any legislative vehicle that moves this year!

We need you to continue to press legislators and make your voice heard! Legislators are scheduled to be away from Washington from July 25 through September 2. This is a great opportunity to host members of Congress or their key staff for a visit to your pharmacy. Face-to-face meetings are the best way to convey the urgency of pushing robust PBM reforms across the finish line. Click here for resources on NCPA’s Month of Action or let us know of your interest in participating by completing this interest form or by emailing Michael Rule at mrule@ncpa.org. Keep the pressure on Congress to finish the job! 

NCPA Joins Other Pharmacy Organizations in Urging Insurers to Maintain Vaccine Coverage

This week, NCPA joined the American Society of Health-System Pharmacists, American Association of Colleges of Pharmacy, American Association of Psychiatric Pharmacists, American College of Clinical Pharmacy, Hematology/Oncology Pharmacy Association, American Pharmacists Association, American Society of Consultant Pharmacists, and the National Alliance of State Pharmacy Associations in sending letters to some of the nation's largest health insurers and their trade association requesting that insurers maintain existing coverage for vaccines without increases or changes to patient cost-sharing. You can read the letter to the trade association, AHIP, here. 

The letters share concerns about ongoing access to vaccines after changes to the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices. The organizations emphasized that the science underpinning the role of vaccines in disease prevention remains unchanged. The letters urge insurers to continue to cover vaccines without imposing increased cost burdens for patients, unless there is clear evidence of harm or a high likelihood of adverse effects.

Strong PBM Reforms Enacted in North Carolina

Gov. Josh Stein (D) signed into law SB 479 with wide ranging provisions to regulate PBMs and PSAOs.  The new law requires networks to accept any willing provider and prohibits multiple accreditations to enter specialty pharmacy networks.  It requires PBMs to report on their use of spread pricing, strengthens audit protections, and addresses patient steering.  The law also assigns fiduciary duty to PBMs.  It prohibits PBMs from reimbursing their owned or affiliated pharmacies more than other pharmacies and requires most rebate savings be passed along to patients.  The law defines pharmacy deserts, and it tasks the Board of Pharmacy with tracking pharmacy openings and closures.  PBMs contracts are prohibited from requiring an independent pharmacy or any pharmacy in a pharmacy desert to accept reimbursement for providing a covered prescription drug, device, or service at a rate less than the acquisition cost for the covered drug, device, or service. The law also extends the state’s current policy of reimbursing pharmacies in the Medicaid Managed Care program with the fee-for-service methodology through June, 2031.  NCPA provided periodic consultation to its members who were leading the Patients Health Access Coalition, one of the primary drivers of the bill.  Congratulations to all pharmacy stakeholders for their legislative success! 

Pharmacy Taxes Defeated

In Massachusetts, Gov. Maura Healey (D) recently signed the budget into law, formally concluding pharmacy stakeholder fears of a $2 tax per prescription.  NCPA worked with various stakeholders to oppose the pharmacy tax when it was first proposed in the Governor’s budget. The proposal intended to bring down additional federal dollars that could increase Medicaid pharmacy dispensing fees, although there were never solid details.  Besides the cash flow and administrative burdens of collecting taxes, NCPA warned about the improbability that CMS would approve such a scheme, noting that the federal government has been cracking down on provider taxes.  NCPA also worked with pharmacy stakeholders in Maine earlier this year to defeat a similar proposed tax of $0.70 per prescription, writing to legislators during the committee process and issuing a grassroots call to action.  Kudos to the state associations and other stakeholders in Maine and Massachusetts who galvanized to stop these burdensome pharmacy taxes. 

Ex-PCMA President Calls for Reining in Middlemen

In an opinion piece for RealClearHealth, Mark Merritt, former president and CEO of the PBM lobbying group the Pharmaceutical Care Management Association, wrote that instead of trying to "import drug pricing models from European health systems" through the most-favored-nation drug pricing model announced earlier this year, the federal government should "stop protecting middlemen and favoring those in government programs over those with private health insurance." 

While Merritt doesn't use the words "pharmacy benefit manager," he repeatedly refers to middlemen in ways that could only apply to PBMs. For once, we seem to be in agreement with an (ex)-PCMA executive. A broken clock is right twice a day! 

Reimbursement Round Up

North Carolina SB 479 was signed into law (see above) with wide-ranging provisions that include a requirement that PBM-owned or affiliated pharmacies not be reimbursed more than others.  In California, Gov. Gavin Newsom (D) signed into law AB 116, which included PBM licensure, transparency, and reporting provisions taken from SB 41.  A slimmed version of SB 41 was voted out of the Assembly Committee on Health and further changes are expected as the bill now heads to the Assembly Judiciary Committee.  The Massachusetts budget is now signed into law, ending (for now), the pharmacy tax issue that was also a problem in Maine (see above). 

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.