- NCPA Responds to Cigna Pharmacy Payment Announcement
- Senate HELP and Finance Hearings Discuss PBM Reform
- HRSA Approves 340B Rebate Model Plans
- NCPA Discusses Pharmacy Issues with IRA At Recent BIO Panel
NCPA Responds to Cigna Pharmacy Payment Announcement
NCPA issued a statement responding to Cigna’s announcement of a new payment model it says will be more transparent and support independent pharmacies. The statement credits President Trump for forcing the apparent change, but cautioned that the devil is in the details, noting that “we don’t know yet whether this is a genuine transformation or whether it’s a head fake to get the heat off.” Cigna’s announcement was also the subject of NCPA CEO’s B. Douglas Hoey’s Executive Update this week.
Our skepticism of Cigna’s announcement was also shared with all Congressional offices and we reminded Congress that without legislation, Cigna can revert back to its current practices anytime. We urged Congress to pass the PBM reforms that were agreed to last December this year, and a story in Modern Healthcare (subscription required) noted that Congress was looking at moving PBM legislation despite this announcement. Take a moment to voice your support and reinforce the need for Congressional action on PBM reform by clicking here.
You can read the statement on NCPA’s LinkedIn page.
Senate HELP and Finance Hearings Discuss PBM Reform
This week, the Senate HELP Committee held a hearing titled, “The Future of Biotech: Maintaining U.S. Competitiveness and Delivering Lifesaving Cures to Patients,” to examine how to “better deliver lifesaving cures to patients and maintain American dominance in medical innovation.”
What stood out at this committee was when Senator Josh Hawley (R-Mo.) drilled down on the growing consolidation in the PBM market, stating the lack of competition leads to higher prices and reduces access to pharmacies, he also suggested that PBMs should be prohibited from purchasing other health care sectors. You can watch the hearing here.
That same day, the Senate Finance Committee held a hearing regarding four nominations including that of Thomas March Bell of Virginia to be Inspector General of the Department of Health and Human Services (HHS). Chairman Crapo (R-Idaho) described the role of the HHS Office of the Inspector General (OIG) as responsible for preventing and detecting fraud, waste, and abuse and advancing the economy, efficiency, and effectiveness of HHS programs, including Medicare and Medicaid. He stressed the importance of the OIG in ensuring that “American taxpayer dollars are used effectively.”
Ranking Member Wyden (D-Ore.) called for action on solutions including pharmacy benefit manager (PBM) reforms in his opening statement to which Chairman Crapo noted support for advancing PBM reform. The nomination hearing went on to discuss the oversight of OIG of Medicare Advantage, Nursing Homes, the Opioid Crisis, and other topics. Currently, there is not a date set for the committee’s vote on Mr. Bell’s nomination. You can watch the hearing here.
HRSA Approves 340B Rebate Model Plans
The Health Resources & Services Administration (HRSA) has approved manufacturer 340B Rebate Model Pilot Program plans, which will begin on January 1, 2026. NCPA submitted comments on the proposed rebate model back in September. In its comments, NCPA called for timely reimbursement to pharmacies and stipulating that no additional administrative costs of running the rebate model be imposed on pharmacies.
The rebate pertains to the transaction between the manufacturer and the covered entity (CE). The pilot program will apply to the NDC–11s of the first 10 drugs in the Medicare Drug Price Negotiation Program, regardless of payer. The pilot program will last for a minimum of one year.
Basically, the rebate would be a reimbursement made from the manufacturer to the CE in the amount of the acquisition cost less the 340B ceiling price. The 340B covered entities would have to purchase these drugs at the going rate and wait for the manufacturers to receive a rebate.
HRSA has approved the plans for the following drugs: Eliquis (Bristol Myers Squibb); Enbrel (Immunex Corporation); Farxiga (Astra Zeneca); Imbruvica (Pharmacyclics); Januvia (Merck Sharp Dohme); Jardiance (Boehinger Ingelheim); Novolog/Novolog Flexpen/Novolog Penfill/Fiasp/Fiasp Flextouch/Fiasp Penfill (Novo Nordisk Inc.); Stelara (Janseen Biotech, Inc.); and Xarelto (Janssen Pharmaceuticals).
For more details, click here. NCPA will keep its members updated on developments.
NCPA Discusses Pharmacy Issues with IRA At Recent BIO Panel
NCPA staff Steve Postal recently served as a panelist in Biotechnology Innovation Organization (BIO)’s 2025 Patient Advocacy Changemaker's Event, where panelists discussed the implementation concerns and access barriers of the Inflation Reduction Act (IRA).
Steve focused on the ongoing financial concerns that pharmacies are facing from the IRA. Steve discussed how manufacturer refunds and PBM/plan reimbursements remain largely unknown. Steve also cited the seven-day expected delays in payments from manufacturer refunds, $11,000 weekly cash flow shortfalls waiting for such refunds, the $43,000 annual loss due to decreased margins on the drugs as cited by the 3Axis Advisor study, and the NCPA survey of members that indicated that 86 percent of respondents are either considering or have already decided to not stock one or more drug in the Medicare Drug Price Negotiation Program.
Additional panelists included Ryan Gough, Executive Director of Partnership to Advance Cardiovascular Health, Daneen Sekoni, Vice President of Policy and Advocacy of Cancer Support Community (CSC), and Jennifer Snow, Founder and Managing Director of Apteka. The panel was moderated by Karin Hoelzer, Senior Director, Patient Advocacy of BIO.
For NCPA’s advocacy and other resources on the IRA, click here.
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.