• Rep. Carter and FTC Chair Ferguson Visit Atlanta Pharmacy
• House Oversight Committee presses PBMs on GPOs 
• CMS Putting PBMs on Alert in MDPNP
• Reps. Van Duyne and Schnieder Introduce Long-Term Care Legislation
• Fall COVID vaccines–the latest from FDA
• NCPA asks Department of Labor to regulate PBM compensation under ERISA
• NCPA Submits Comments to CMS Opposing Bundled Payment of Phosphate-lowering Therapies in Medicare Part D
• NCPA Submits Comments to CMS Opposing One Year DMEPOS Accreditation
• Reimbursement Round-Up
• NCPA State Legislative Activity Update

Rep. Carter and FTC Chair Ferguson Visit Atlanta Pharmacy

This week, Rep. Buddy Carter (R-Ga.) and Federal Trade Commission Chairman Andrew Ferguson toured Briarcliff Pharmacy in Atlanta today with pharmacy owner Jonathan Marquess. Carter, who is also a pharmacist, has a long history of championing pharmacy causes in Congress, including PBM reform. He was one of the members of Congress who recently introduced the PBM Reform Act (H.R. 4317). Ferguson has also voiced major concerns about PBM conduct and joined NCPA staff in March for a pharmacy visit in Virginia. The FTC is still conducting a 6(b) study on the impact of PBMs on patients and pharmacies.

Additionally, as part of the Month of Action, health staff for Senate Minority Leader Charles Schumer (D-N.Y.) visited Village Apothecary in Greenwich Village in New York City where the pharmacy staff reinforced the need for PBM reform to pass expeditiously.

While the Month of Action is wrapping up, there will be more opportunities throughout the year to host your legislators for a visit. You can use this interest form to express interest in hosting a visit.

With Congress returning to Washington next week, continue to make your voice heard on the necessity for PBM reform. Click here to contact your Representative and urge them to cosponsor the H.R. 4317. Keep the pressure on Congress to finish the job!

House Oversight Committee presses PBMs on GPOs

Rep. James Comer (R-Ky.), chairman of the House Committee on Oversight and Government Reform, is stepping up Congress’ investigations into pharmacy benefit manager practices by seeking information about PBMs use of group purchasing organizations (GPOs) headquartered overseas. In two near-identical letters, Comer notified the CEOs of Optum Rx and Cigna that the committee is looking into whether both companies use their "foreign headquartered group purchasing organization ... to evade transparency and oversight in the United States.” Cigna/Express Scripts operates Ascent Health Services, headquartered in Switzerland, and UnitedHealth’s Optimized controls Emisar Pharma Services in Ireland.

Comer noted that GPOs "appear to be yet another example of the institutional intent at opacity and avoidance of oversight within your company…the committee is concerned that your company’s opaque business practices and relationships, including the creation of new corporate structures abroad, combined with unchecked integration, is hurting patients and costing taxpayers.” Comer requested that the companies disclose a range of materials to the committee about how these subsidiaries operate.

The committee held a hearing in July 2024 in which members grilled the CEOs of the Big Three PBMs; GPOs played a role in that hearing as well, with Republicans and Democrats raising concern over the role of these subsidiary companies. Rep. Greg Casar (D-Texas) asked OptumRx CEO Patrick Conway, “If these GPOs are generating this much more in fees, where is the value to the American people? Why is it that annual premiums continue to go up? Why is it that thousands of drugs have seen price increases, while billions of dollars in new fees and profits are going to PBMs via their GPOs?”

CMS Putting PBMs on Alert in MDPNP

CMS has put PBMs on alert in a recent memo on the Medicare Drug Price Negotiation Program (MDPNP). See below for some key highlights from the memo.

Fair reimbursement.CMS stated that it continues to hear concerns that pharmacies might be reimbursed by Part D plan sponsors below the price the pharmacy paid to acquire the selected drug, including potentially below the maximum fair price (MFP) for the selected drug. CMS will closely monitor for whether further programmatic adjustments are needed to address any contrary practices that emerge.

Dispensing fees. CMS stated that it expected Part D plan sponsors’ dispensing fees to sufficiently compensate network pharmacies so that enrollees can be assured network access to selected drugs. CMS stated that examples of pharmacy costs that can be included within the dispensing fee are salaries, time associated with checking for coverage, filling the container, packaging, and overhead (including IT).

Network adequacy. Finally, CMS reminded all Part D plan sponsors of the network adequacy requirements for contracted pharmacies.

For resources and NCPA’s advocacy on the MDPNP, see here.

Reps. Van Duyne and Schnieder Introduce Long‑Term Care Legislation

Last week, Reps. Beth Van Duyne (R-Texas) and Brad Schneider (D-Ill.) introduced H.R. 5031, the Preserving Patient Access to Long-Term Care Pharmacies Act, which would address upcoming Medicare Part D drug pricing changes that will impact the quality of care for seniors in nursing homes, assisted living facilities, and other long-term care settings.

This legislation would establish a targeted $30 supplemental supply fee on prescription drugs subject to Medicare-negotiated prices. NCPA is proud to have endorsed this legislation. If you would like to help build support for this legislation you can click here to contact your member of Congress.

Fall COVID vaccines–the latest from FDA

The FDA has approved COVID-19 vaccines targeting strains related to the JN.1 variant for individuals 65 and older and those who have underlying conditions that put them at higher risk. For these higher-risk individuals, Moderna's mNEXSPIKE and Novavax's Nuvaxovid are approved for people who are 12 years and older, Moderna's SPIKEVAX is approved for people 6 months and older, and Pfizer's COMIRNATY is approved for people 5 years and older. mNEXSPIKE, SPIKEVAX, and COMIRNATY utilize mRNA technology while Nuvaxovid is protein-based. People over 6 months who don't fall into the high-risk category can still get the vaccines, with the approval of a doctor.

The FDA must complete its lot review process to release the vaccine for distribution, which may take a few days to weeks; however, vaccine supply should start arriving soon based on pharmacies' preorders.

Pharmacists' authority to order and administer COVID vaccines is determined by their state. Many states tie that authority to an ACIP recommendation. ACIP has not yet met to offer recommendations based upon the FDA's approval and we are waiting to hear when a meeting will be scheduled. If your state authority to vaccinate is tied to an ACIP recommendation, please wait to begin administering COVID vaccines unless your state allows it with a prescription for the vaccine from an authorized prescriber. Check with your state pharmacy association or board of pharmacy for information specific to your state.

NCPA is working closely with other professional pharmacy associations to advocate for solutions that ensure patients have access to COVID vaccines this fall.

NCPA asks Department of Labor to regulate PBM compensation under ERISA

NCPA has submitted a letter to the secretary of the U.S. Department of Labor (DOL) asking the DOL to regulate PBM compensation practices under the Employee Retirement Income Security Act of 1974. This is a longtime ask from NCPA. DOL's actions in this space have recently resurfaced based on President Trump's Executive Order issued on April 15, 2025, Lowering Drug Prices by Once Again Putting Americans First, which tasked the DOL with implementing measures to reduce prescription drug costs.

NCPA's requests include the following:

Require full transparency from PBMs in their dealings with ERISA-covered plans, including clear disclosures of pricing structures, rebates, and compensation arrangements.

Establish safeguards against excessive PBM compensation, particularly by limiting such compensation to bona fide service fees.

Define acceptable compensation standards that separate PBM revenue from drug list prices—for example, banning percentage-based fees that scale with drug list prices.

NCPA is tracking the DOL's activity closely and will report out to members as we learn more.

NCPA Submits Comments to CMS Opposing Bundled Payment of Phosphate-lowering Therapies in Medicare Part D

NCPA submitted comments to CMS on its end-stage renal disease (ESRD) proposed rule for calendar year 2026. In the CY 2025 ESRD final rule, effective Jan. 1, 2025, CMS incorporated oral-only phosphate binders into the End-Stage Renal Disease Prospective Payment System bundled payment, stating that these therapies are no longer separately billed under Medicare Part D.  

In the current comments, NCPA argued that patients’ previous access to phosphate-lowering therapies (PLTs) through Medicare Part D was an essential lifeline for individuals managing kidney disease. NCPA continued to oppose the bundling of such services, as it threatens to limit access to these therapies at community pharmacies, raise out-of-pocket costs, and undermine care quality for vulnerable patients. 

Additionally, NCPA recommended that CMS enforce the compliance packaging requirements to ensure dialysis providers meet the same standards as LTC pharmacies. 

NCPA Submits Comments to CMS Opposing One Year DMEPOS Accreditation, Putting CGM and Insulin Pumps in Competitive Bidding

NCPA submitted comments to CMS on its calendar year 2026 home health and DMEPOS proposed rule. In the comments, NCPA opposed CMS’ proposal that, if finalized, would require DMEPOS suppliers to be surveyed and reaccredited every year (as opposed to the current 3-year cycle), due to the increased administrative burden and costs expected for pharmacies, among other reasons.

Additionally, NCPA opposed CMS’ proposal to reclassify all continuous glucose monitors (CGMs) and insulin infusion pumps under the DMEPOS competitive bidding program (DMEPOS CBP). NCPA also urged CMS to expand access to needed diabetes services, specifically by covering CGM that is delivered by pharmacists and other qualified practitioners under direct or general (preferable) supervision.

Reimbursement Round-Up

NCPA presented virtually to Hawaii’s State PBM Working Group, providing information and support to stakeholders, including officials from various state agencies, as the group weighs options for pursuing PBM reform in 2026.   NCPA has been working with the SaveNJRx, a pharmacy coalition comprised of all pharmacy stakeholders in New Jersey, in anticipation of fall activity on NADAC + legislation in both the commercial and Managed Medicaid markets.  Stay tuned for information about SaveNJRx’s upcoming webinar in September, which will detail opportunities for engaging these critical issues.  NCPA eyes are on Wisconsin SB 203, a strong and wide-ranging PBM reform bill with a NADAC + reimbursement requirement in the commercial market.  An amendment was recently adopted and the bill approved by the Senate Committee on Health, making it eligible for consideration by the full Senate.

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.