Congressional Spending Bill to Include Key PBM Contracting Reform

On Tuesday, Congress released details behind its 4-part spending package, which featured key pharmacy benefit manager (PBM) reform, according to Politico.¹

In its 2026 appropriations bill for the Department of Labor and the Department of Health and Human Services (HHS), Congress is set to require the Centers for Medicare & Medicaid Services (CMS) to explicitly outline “reasonable and relevant contract terms” for pharmacies dispensing Medicare Part D drugs, according to a National Community Pharmacists Association (NCPA) release.²

“This is a major win for independent and long-term care community pharmacy, and we are very pleased to have worked with congressional leadership to advance it,” said NCPA in a statement.³ “We are very grateful to our pharmacy champions, including Representative Buddy Carter (R, Georgia) and Senators Mike Crapo (R, Idaho) and Ron Wyden (D, Oregon), and other leaders in Congress for including this language in the funding bill, and we strongly urge all members of the House to pass and send it to the Senate.”

Less than 3 months removed from the record-breaking government shutdown that ended in November 2025,⁴ Congress is again working to fund HHS and other government departments through September 30, 2026.¹

READ MORE: Independent Pharmacies’ Current Hope for State, Federal PBM Reform

According to The Hill, some parts of the spending package may be accompanied by scrutiny and contention among lawmakers, such as funding for the Department of Homeland Security and Immigration and Customs Enforcement (ICE) amid recent news in Minneapolis and various other areas across the country.⁵ However, provisions within the spending package regarding HHS are being applauded by lawmakers on both sides of the aisle, as well as the pharmacy industry and health care advocates.¹

“For many decades, PBMs have had the advantage of inconsistent, vague, and unreasonable contract terms that they would interpret and enforce in ways that can’t be explained or justified,” continued the NCPA.³ “This reform will create clarity and enforceability, and that should reduce the confusion that PBMs have used to their advantage.”

What These Congressional Provisions Do for Pharmacies

As the NCPA news release stated, provisions within this new spending package represent “the first major legislative change to Medicare Part D directly impacting pharmacy in almost 20 years.” Forcing PBMs out of any potential for predatory contracting, the new statute, if signed into law, would force CMS to define reasonable and relevant contract terms for all PBMs and pharmacies operating within Medicare Part D plans.²

PBMs have significantly come to light within the health care community as of late, thanks to notable events like the Federal Trade Commission (FTC) interim staff report in 2024 and increased attention toward these prescription drug middlemen in Washington, DC.⁶ And while many of their practices have been known to impact multiple areas of an independent pharmacy’s financial sustainability, PBM contracting has been a key challenge for pharmacies dispensing Medicare drugs.

Historically, with their advanced understanding of administrative relationships and contracting under Medicare, PBMs employed “lopsided and unilateral contracting practices” that have since been uncovered by the FTC and other entities.

“PBMs exert substantial influence over independent pharmacies, who struggle to navigate contractual terms imposed by PBMs that they find confusing, unfair, arbitrary, and harmful to their businesses,” wrote authors of the FTC report.⁶ “Evidence suggests that increased concentration may give the leading PBMs the leverage to enter into complex and opaque contractual relationships that may disadvantage smaller, unaffiliated pharmacies and the patients they serve.”

Provisions under the new spending bill would essentially take away the top PBMs’ ability to take advantage of these contracts. While the specific requirements haven’t been laid out, PBMs will now be forced toward much greater transparency when contracting under Medicare Part D.²

Additional Provisions and the Statute’s Future Outlook

The government is allocating $188 million to facilitate these new contracting requirements. Furthermore, Congress is also providing pharmacies with the opportunity to report contract violations, while the government has the ability to enforce penalties for said violations.

Finally, the spending package will also delink PBMs’ Medicare Part D compensation from drug prices while establishing an “essential retail pharmacy” designation to monitor payment trends and network inclusion.²

The bill will now be sent to the House of Representatives floor, where its supporters hope it will be signed and passed to the Senate.

“This important legislation is taking the fight to the PBMs in lowering drug prices, improving pharmacy access for patients, and leveling the playing field for community pharmacy,” concluded authors of the NCPA news release.² “NCPA strongly supports the legislation, and we will urge all members of Congress to vote yes when the bill comes to the floor at the end of this week.”

READ MORE: Top 5 Videos of 2025 Focus Primarily on PBM Reform

Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our free Drug Topics newsletter.

REFERENCES

1. King R, Guggenheim B. Congress clinches bipartisan health deal. Politico. January 20, 2026. Accessed January 21, 2026. https://www.politico.com/live-updates/2026/01/20/congress/congress-clinches-health-deal-to-crack-down-on-drug-intermediaries-00736680

2. A long time coming: NCPA priority included in appropriations bill. News Release. NCPA. January 21, 2026. Accessed January 21, 2026. https://ncpa.org/newsroom/qam/2026/01/21/long-time-coming-ncpa-priority-included-appropriations-bill

3. NCPA applauds Medicare Part D reform in new spending bill. News Release. NCPA. January 20, 2026. Accessed January 21, 2026. https://ncpa.org/newsroom/news-releases/2026/01/20/ncpa-applauds-medicare-part-d-reform-new-spending-bill

4. Ward M. Federal government shutdown ends - November 2025. American College of Sports Medicine. November 17, 2025. Accessed January 21, 2026. https://acsm.org/policy-corner-november-2025-government-shutdown-ends/

5. Kochi S. Top appropriators release text for four remaining appropriations bills. The Hill. January 20, 2026. Accessed January 21, 2026. https://thehill.com/homenews/house/5696414-appropriations-bills-house-deadline/

6. Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies. FTC; July 9, 2024:1-73. Accessed January 21, 2026. https://www.ftc.gov/system/files/ftc_gov/pdf/pharmacy-benefit-managers-staff-report.pdf