• NCPA Podcast Reflects on Rutledge Decision Five Years Later
• Pharmacists Fight Back Act Reintroduced in the House·        
• Gradual Wins Emerging at NAIC 
• CVS to Pay Okla. Pharmacists $5 Million for Under-reimbursement
• Reminder: Enroll in MTF ASAP
• What You Need to Know About Upcoming WAC Decreases
• CMS Fails to Include Phosphate Binder Reform Suggested by NCPA in ESRD Final Rule
• USPS Modernization Effort Could Undermine Medication Delivery Speeds, Especially in Rural Areas, Report Says
• CMS Phasing Out Paper CLIA Certificates

NCPA Podcast Reflects on Rutledge Decision Five Years Later

This week marked the fifth anniversary of the Supreme Court’s landmark decision in Rutledge v. PCMA. In a special edition of NCPA's official podcast, "Independent Rx Forum," several experts weighed in on the landmark victory for state regulation of PBMs. NCPA General Counsel Matt Seiler is joined by Arkansas Supreme Court Justice Hon. Nicholas Bronni; Robert T. Smith, a partner the law firm Katten and a specialist in PBM litigation; and Arkansas Pharmacists Association CEO John Vinson to understand how the case affected PBM regulation nationwide and how it will affect future cases. 

You can listen to the episode here or wherever you get your podcasts.

Pharmacists Fight Back Act Reintroduced in the House

Along with a press conference outside the U.S. Capitol building on Thursday where legislators, pharmacists (including Steve Moore, owner of Condo Pharmacy and member of the NCPA Board of Directors), and pharmacy allies spoke about challenges pharmacists deal with daily and the dire need for PBM reform, Reps. Jake Auchincloss (D-Mass.), James Comer (R-Ky.) and Diana Harshbarger (R-Tenn.) added to the suite of significant PBM reform bills currently pending in Congress by reintroducing the Pharmacists Fight Back Act (HR 6609 and HR 6610). NCPA was proud to endorse this legislation when it was first introduced last year. “PBM reform would rein in the big health insurance lobby, make prescription drugs more affordable for consumers, and throw a lifeline to the thousands of small, family-owned pharmacies that are on the brink of closure,” NCPA CEO Douglas Hoey said. “We are continuing to push hard, along with our allies, for Congress to finalize PBM reform legislation and send it to the president’s desk as soon as possible.”  

Read about the Pharmacists Fight Back Act, and click here for the full press conference.

Gradual Wins Emerging at NAIC 

NCPA State Government Affairs Director Joel Kurzman attended the fall meeting of the National Association of Insurance Commissioners. To quickly summarize relevant proceedings, the PBM Working Group advanced its draft guidelines for PBM licensure, continues with its feedback period on a new draft chapter of its market conduct manual pertaining to PBM examinations, and is proceeding to develop a PBM-specific complaint form that can be offered to all states. The new development of the PBM-specific complaint form is a big win for NCPA, as we have been advocating for this issue throughout our years of engagement at NAIC. We will continue to engage and provide feedback as this important resource is further developed. 

CVS to Pay Okla. Pharmacists $5 Million for Under‑reimbursement

CVS Caremark will pay over $5 million in a settlement with the state of Oklahoma over allegations it under-reimbursed pharmacies in the state. The state will distribute 75 percent of the funds to eligible pharmacies that filled over 68,000 prescriptions between January 2024 and August 2025 and were paid less than what the drugs cost. The office of the state attorney general, Gentner Drummond, will keep the other 25 percent.

CVS also agreed to various reforms including reviewing pharmacy payment disputes against national cost benchmarks, allowing pharmacies to use documentation of actual costs when challenging payments, and other actions.

Eligible pharmacies will be notified in writing by the attorney general's office, with instructions for receiving payments under the settlements. If you believe your pharmacy was paid below cost, you can file a complaint here.

Read the attorney general's statement on the settlement here.

Reminder: Enroll in MTF ASAP

You have probably received an email from the Centers for Medicare & Medicaid Services (CMS) on enrolling in the Medicare Transaction Facilitator (MTF) of the Medicare Drug Price Negotiation Program (MDPNP). If you are going to participate in any Medicare Part D network for next year, you must enroll in the MTF Data Module (MTF-DM) to receive your manufacturer refund payments. We encourage you to become familiar with the process before enrolling.

Here are some things to know:

- You can watch an intro to the MTF on CMS' dispenser homepage here.

- You can view a FAQ from CMS on the MTF here.

- You can contact CMS at MFPMedicareTransactionFacilitator@cms.hhs.gov with any questions. Additional support options can be found at https://mtf.helpdesk.cms.gov/home.

- Before enrollment, you should make sure your NCPDP profile is accurate and updated.

- Before enrollment, pharmacies need to know which functions, such as central pay or reconciliation services, they want to assign to any third-party support entities such as PSAOs or reconciliation vendors.

- During enrollment pharmacies will need to sign a legal agreement, so proceed with caution and be sure to carefully review and have your legal counsel review.

- During enrollment, identify as having "material cashflow concerns," as manufacturers can provide pharmacies with a plan for mitigating their cashflow concerns.

We strongly urge you to enroll before Jan. 1, 2026, though there is no hard deadline to complete enrollment (it will be ongoing to accommodate new pharmacies, for example). It will take approximately one hour and you will have to provide banking information.

Additional CMS resources:

- CMS pharmacy toolkit on the MTF of the MDPNP. This resource includes a link and instructions to enroll, other resources for pharmacies, and reminders about how to keep your NCPDP data up to date.

- CMS webinar to NCPA members on enrollment in the MTF. The webinar can be found here.

- Various CMS MTF resources available here, including the MTF Enrollment Quick Guide to the CMS Help Desk website under the Browse Resources section. This is designed to assist pharmacies, other dispensing entities, and third-party support entities with the MTF enrollment process.

For NCPA advocacy on the MDPNP and on the Inflation Reduction Act generally, click here.

What You Need to Know About Upcoming WAC Decreases

Wholesale acquisition costs (WACs) for several popular drugs are coming down significantly, and these are the biggest WAC reductions in history! When this reference price change goes into effect, PBM reimbursements will likely also be lower. If you act quickly, you'll be able to avoid losses on these products that you have purchased at a higher price. NCPA has created a list of the drugs we know are being affected; you can read that here. 

Each wholesaler has their own policy on returns and timelines, so keep your eye out for notices from them detailing how to return medicines with upcoming reduced WACs and when they may institute return blocks. Act as quickly as you can to clear these drugs off your shelves by reviewing your inventory, cross-checking the products with WAC decreases, and streamlining your inventory. Take them out of your will-call box, too; if the patient requests these prescriptions, consider ordering them on demand. 

Take these steps to avoid tens of thousands of dollars in added costs:

- Review your inventory.

- Cross-check the products with WAC decreases;

- Call patients with prescriptions in will call and remind them to pick up (or offer delivery) to avoid returning these drugs to stock;

- Pay close attention to WAC reduction announcements from your wholesaler;

- Make sure that you fully understand any return blocks implemented by wholesalers;

- Streamline your inventory immediately;

- Take full advantage of on-demand ordering; and

- Enroll in CMS' Medicare Transaction Facilitator program immediately to make sure that you are getting manufacturer refund payments for the first 10 Medicare negotiated drugs under the Medicare Drug Price Negotiation Program.

For a little more context, tune in to our recent episode of "Independent Rx Forum," NCPA's official podcast, on the WAC reductions and the actions pharmacists should take now to protect their margins. Listen here or wherever you get your podcasts.

Click here for more information, including a list of drugs with WAC decreases that are known to NCPA.

CMS Fails to Include Phosphate Binder Reform Suggested by NCPA in ESRD Final Rule

CMS issued its end-stage renal disease (ESRD) final rule for CY 2026. In that rule, CMS stated that despite comments requesting that ESRD facilities provide oral drugs and biological products in specific packaging for nursing homes and include the cost of pharmacist and pharmacist technician salaries in the ESRD PPS bundled payment, CMS is not providing detailed responses to these comments in this final rule, but will consider them in future rulemaking. NCPA submitted comments in August to CMS arguing for these reforms. 

However, CMS noted that it did not propose to change the additional $36.41 increase to the Transitional Drug Add-on Payment Adjustment (TDAPA) amount for phosphate binders, and CMS is not finalizing any such changes in this rule. As such, the monthly TDAPA amount on any ESRD PPS claim that reports units of phosphate binders in CY 2026 would include the increased $36.41 that CMS finalized in the CY 2025 ESRD PPS final rule.

In the CY 2025 ESRD final rule, effective Jan. 1, 2025, CMS incorporated oral-only phosphate binders into the ESRD Prospective Payment System bundled payment, stating that these therapies are no longer separately billed under Medicare Part D. In comments in August, 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. 

USPS Modernization Effort Could Undermine Medication Delivery Speeds, Especially in Rural Areas, Report Says

A report issued by the Brookings Institution states that an ongoing reorganization of the U.S. Post Office’s mail processing network could create slower and less predictable medication delivery, especially for communities dependent on mail services for prescription access. It found that around 3.7 million Medicare-eligible Americans live in communities that lack strong retail pharmacy access and rely heavily on mail-order prescriptions that could see their deliveries impacted by the restructuring effort. 

In its report, Brookings noted the importance of mail-order prescriptions for medication adherence, stating that for communities most dependent on mail services for prescription access, “even small increases in delivery time can disrupt medication adherence and continuity of care.  In this way, delivery speed is not merely a performance metric: It is a determinant of medication adherence and population health.”

The think tank’s findings come from an analysis of 2019 prescription transaction data for asthma and diabetes medications in combination with measures of retail pharmacy access, reliance on mail-order prescriptions, and exposure to the restructuring effort.

Part of the larger Delivering for America program that is aimed at streamlining USPS operations, the Regional Transportation Optimization initiative entails transferring mail that was being processed locally to larger, regional facilities, while several local post offices switch to a single daily collection schedule for outgoing mail. However, the Brookings report highlights another analysis conducted by the Postal Regulatory Commission, an oversight body, which found the service changes could cause uneven delivery slowdowns across the country, especially in rural areas. 

Read the report here.

CMS Phasing Out Paper CLIA Certificates

CMS recently announced that all laboratories, including pharmacy-based laboratories with a CLIA certificate of waiver, must switch to email notifications by March 1, 2026. After that deadline, CMS will no longer mail paper fee coupons or issue paper certificates.

For more information about the three options for making the switch to electronic notifications see this document.

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.