A New Era of Fairness and Transparency in PBM-Pharmacist Relationships

The landscape of pharmacy benefit management is undergoing a structural transformation that promises to redefine the financial and operational reality for pharmacists across the US.

In a recent webinar titled “PBMs, Transparency and Fiduciary Responsibility”—hosted by Drug Topics and Managed Healthcare Executive—industry experts Jeff Hogan and Chad Worz, PharmD, BCGP, FASCP, detailed a series of federal and state reforms that they describe as the most significant shifts in the past 2 decades.

“These are profound changes; the most reform in the last 20 years,” said Chad Worz, executive director and chief executive officer at the American Society of Consultant Pharmacists (ASCP). “They're not incremental tweaks, and they directly address the predatory contracting that has squeezed pharmacies for years.”

READ MORE: How States and Federal Government Are Reforming PBM Practices for Pharmacy Viability | APhA 2026

Along with Jeffrey Hogan, managing director and co-founder of Judi Group, the speakers graced the Drug Topics and Managed Healthcare Executive audiences with their perspectives on the recent signing of major pharmacy benefit manager (PBM) reform in February through the Consolidated Appropriations Act of 2026 (CAA 2026).

For pharmacists who have long felt the squeeze of predatory contracting and opaque reimbursement models, this discussion provides a vital roadmap for navigating a future where transparency is no longer optional but a legal mandate.

The centerpiece of the discussion is CAA 2026, which Hogan characterized as “by far the most sweeping PBM reform in ERISA history.” This legislation mandates a 100% rebate pass-through and provides employers with non-waivable audit rights, effectively stripping away the “black box of opacity” that has allowed PBMs to thrive on hidden spreads.

Hogan explained that recent court cases, such as Stern vs JP Morgan, have established that PBM selection and contract renewal are now fiduciary functions, exposing plan sponsors to liability if they fail to address opaque pricing. This shift is critical for pharmacists because it forces employers—the ultimate payers—to finally demand the same transparency and fair dealing that pharmacies have requested for years.

From the clinical and operational side, Worz emphasized that these reforms represent a “full circle moment” for the profession. He noted that CAA 2026 directs the Centers for Medicare and Medicaid Services (CMS) to define and enforce “reasonable and relevant contract terms,” including reimbursement that covers the actual cost to dispense medications.

He also argued that the industry must move away from a model where pharmacies are forced to hide their business expenses within product margins, often resulting in dispensing fees as low as 5 cents, when the actual operational costs are closer to $15. According to Worz, “we’ve got to pay pharmacists for doing what pharmacists do,” rather than forcing them to rely on the spread of drug pricing to survive.

The webinar also explores the profound impact of recent FTC consent orders against the “Big 3 PBMs”—Express Scripts, CVS Caremark, and Optum Rx. Hogan noted that these orders establish a “fiduciary, prudent PBM model” that will likely become the standard for the entire industry, mandating cost-plus pharmacy reimbursement.

This shift toward transparency is being accelerated by technology that allows employers to see exactly where their money is going, effectively deconstructing the old model. Hogan observed that while the system is complex, experts are witnessing the creation of a “bonafide health care marketplace,” where value and efficacy finally outweigh administrative manipulation.

For pharmacists wondering if now is the time to innovate or even open a new practice, the webinar speakers offered a cautious but optimistic outlook. While the current environment remains a grind, the emergence of state-level legislation and the shift toward outcomes-based care delivery provides new opportunities for “innovative, consumer-focused” pharmacy practices.

To gain more insights on these experts’ perspectives, watch the full webinar here.

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