Federal Actions Could Result in Increased Pharmacy Access, PBM Reform

The PBM Kickback Prohibition Act (HR 7895) and the Main Street Pharmacy Access Act (HR 3164) were both advanced last week in the House Education and Workforce Committee and House Ways and Means Committee, respectively, according to an NCPA news release.¹

With HR 7895 targeting the ability of pharmacy benefit managers (PBMs) to receive kickback compensation, HR 3164 instead focuses on reimbursement under pharmacy-administered test-and-treat services.

“This scheme between PBMs and some brokers is an indefensible, pay-to-play racket,” NCPA CEO B. Douglas Hoey, RPh, MBA, said in a release.² “It’s a clear conflict of interest that makes prescriptions less affordable, and it must be eliminated.”

First scrutinizing the PBM actions HR 7895 is designed to reform, Hoey then commented on the Main Street Pharmacy Access Act, explaining that it “highlights the important role that pharmacy teams play in communities across the country, filling primary care gaps and providing care beyond the dispensing of critical medications.”

READ MORE: PBM Reform in New Jersey Could Bring Unprecedented Transparency

The PBM Kickback Prohibition Act

The PBM Kickback Prohibition Act recently achieved a unanimous 34-0 vote in the House Education and Workforce Committee, signaling a rare moment of bipartisan unity against opaque financial arrangements. This legislation takes direct aim at the relationships between PBMs and the benefit consultants who advise employer health plans.^1,3

Witnesses during recent House hearings testified that these brokers, who are often viewed as neutral advisers, frequently receive per-prescription fees to steer business toward specific PBMs. In some documented instances, PBM contracts have called for payments of $2.50 for every retail prescription and $7 for every mail-order prescription filled, creating an incentive structure that rewards volume and higher-margin channels rather than cost savings for patients.³

This “pay-to-play” atmosphere has drawn the scrutiny of the Federal Trade Commission (FTC), especially as the top 3 PBMs now control nearly 80% of all US prescription claims. Lawmakers expressed hope that HR 7895 will be broad enough to prevent PBMs from using loopholes to avoid compliance.^1,3

The Main Street Pharmacy Access Act

Concurrently, the Main Street Pharmacy Access Act is advancing through the House Ways and Means Committee to codify the clinical role of pharmacists in the Medicare program. Formerly known as the Ensuring Community Access to Pharmacist Services (ECAPS) Act, the bill would authorize pharmacists to be reimbursed under Medicare Part B for testing and treating common respiratory illnesses like COVID-19, the flu, RSV, and strep throat.^1,2,4

To address concerns regarding the expansion of medical scope, the bill was narrowed to ensure reimbursement only in states that already allow these services or where pharmacists operate under a collaborative practice agreement. This legislation is viewed as vital for the 91% of seniors who find pharmacy care easy to access, as well as those in rural health care deserts in particular, where traditional primary care is scarce.^1,4

Major industry stakeholders, ranging from independent pharmacy owners to larger systems like CVS Health and Kroger, have praised the bill as a pragmatic, bipartisan solution to address long-standing barriers to care.⁴

These legislative efforts are part of a broader federal crackdown that gained momentum with the Consolidated Appropriations Act of 2026. This law already mandates that PBMs pass through 100% of rebates to employer health plans and requires stricter disclosure of compensation to plan fiduciaries.^3,5

How These Potential Laws Could Affect Previous Reform Efforts

Looking toward 2028, additional reforms will require Medicare Part D plans to compensate PBMs using only flat, bona fide service fees based on fair-market value, effectively eliminating rebate-linked incentives.⁵

Furthermore, a new “Any Willing Pharmacy” provision will take effect in 2028, requiring plan sponsors to allow any pharmacy meeting standard terms to participate in their networks, protecting community pharmacies from exclusionary barriers.

For pharmacists, these actions represent a significant shift toward transparency and professional protection. New requirements mandate that PBMs provide detailed reports on spread pricing and benefit designs that steer patients toward PBM-affiliated pharmacies.⁵

To ensure accountability, PBMs must now grant plan sponsors an annual right of audit to verify the accuracy of transparency reporting. Most importantly, these reforms establish a formal process for pharmacies to report PBM contract violations, backed by explicit protections against retaliation.

Although some Democrats note that PBM reform alone may not solve the problem of high drug prices set by manufacturers, there is a clear consensus that reining in these middlemen is essential for a more competitive and patient-focused pharmacy benefit system.^3,5

“Two major pharmacy-related bills addressing NCPA policy priorities passed out of their respective committees—one on PBM kickbacks and the other on reimbursement for test-and-treat services in pharmacies—in a sign of Congress’ continued attention to pharmacy access,” concluded authors of the NCPA release.¹ “NCPA is grateful to the members of both committees for all their hard work on these bills and will continue to champion them through the legislative process.”

READ MORE: Independent Pharmacy’s Adaptability Through Reform, Closures, and Technology

REFERENCES

1. House committees pass two NCPA policy priority bills. News Release. NCPA. May 22, 2026. Accessed May 26, 2026. https://ncpa.org/newsroom/qam/2026/05/22/house-committees-pass-two-ncpa-policy-priority-bills

2. NCPA supports pharmacy bills being marked up in house committees today. News Release. NCPA. May 21, 2026. Accessed May 26, 2026. https://ncpa.org/newsroom/news-releases/2026/05/21/ncpa-supports-pharmacy-bills-being-marked-house-committees-today

3. Van Bramer J. Congress take aim at alleged kickbacks in hearing on PBMs. Plan Adviser. April 22, 2026. Accessed May 26, 2026. https://www.planadviser.com/spark-iric-create-evaluation-framework-for-dc-retirement-income-products/

4. What they are saying: Smith’s Main Street Pharmacy Access Act clears Ways and Means Committee. News Release. Representative Adrian Smith. May 21, 2026. Accessed May 26, 2026. https://adriansmith.house.gov/media/press-releases/what-they-are-saying-smiths-main-street-pharmacy-access-act-clears-ways-and

5. Morgan L, Collins CM. Sweeping PBM reforms arrive: what the 2026 federal legislation means for pharmacies, patients and employers. Buchanan Ingersoll & Rooney PC. February 12, 2026. Accessed May 20, 2026. https://www.bipc.com/sweeping-pbm-reforms-arrive-what-the-2026-federal-legislation-means-for-pharmacies,-patients-and-employers