PBM Reform Will Profoundly Reshape Pharmacy Business Models

For pharmacies across the US, the wave of pharmacy benefit manager (PBM) reform now sweeping through federal and state policy is not a distant regulatory shift; it is an existential reckoning with the business model that has defined the industry for decades.

“The impact is existential,” said Chad Worz, executive director and CEO of the American Society of Consultant Pharmacists (ASCP). “The dispensing fees that pharmacies may have been forced to accept in the old PBM model—a nickel, when their costs are in the $12-to-$15 range—have to get corrected.”

In a webinar discussion hosted by Drug Topics and Managed Healthcare Executive, Worz and Jeffrey Hogan, managing director of the Judy Group, broke down what sweeping PBM reform means for every player in the pharmacy ecosystem—from large PBMs facing new transparency mandates and liability exposure, to independent and long-term-care pharmacies that have long absorbed the financial squeeze of inadequate dispensing fees and opaque reimbursement models.

The conversation also highlights an important development often overlooked in national headlines: States have not waited for federal action. Many have already passed aggressive PBM legislation targeting anti-steering, anti-consolidation, and most-favored-nation clauses—protections that directly affect a patient’s ability to use the community pharmacist of their choice.

For pharmacy owners and operators trying to make sense of a rapidly shifting landscape, this discussion offers a grounded, expert-level look at what the reforms mean, what still remains to be determined, and why acting now matters.

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

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

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