The Prodigious PBM Pivot: How Supply Chain Entities Will Move Forward After CAA 2026

The Consolidated Appropriations Act of 2026 (CAA 2026) marks the most significant federal pharmacy benefit manager (PBM) reform in the 20-year history of Medicare Part D. For independent pharmacies, understanding what this legislation does, and doesn’t, do is critical.

And, although many advocates in community pharmacy have celebrated this legislation, there is still much more work to be done.

At its core, CAA 2026 targets the perverse incentive that has historically rewarded PBMs for higher drug prices through a practice known as delinking—severing PBM compensation from the cost of the drugs they manage. A new CMS enforcement office, funded at over $150 million, will police “reasonable and relevant” contract terms for Part D. That standard matters because the contracts pharmacies sign today could define what reasonable looks like for years to come.

To tell us more about the nuances behind the future of independent pharmacy, Drug Topics was joined by Douglas Hoey, CEO of the National Community Pharmacists Association (NCPA), and David Blair, CEO of LucyRx, a next-generation PBM looking to reverse the trend of predatory, pharmacy-focused practices.

Companies like Blair’s are gaining serious traction, with employer interest tripling in recent months. But vertical integration among the “Big 3” PBMs remains largely untouched by federal law, meaning the fight is far from over. As long as major PBMs continue to own the pharmacies that dispense drugs, independent pharmacies face an uphill battle against what, in specific instances, amounts to a vertically integrated monopoly.

The pendulum is swinging, however. The question is how fast.

Advocacy efforts are already turning toward Medicaid reform and state-level action to push for cost-plus reimbursement models. Despite CAA 2026 being a landmark win within the pharmacy space, it's only the beginning of a longer road toward a truly transparent and equitable prescription care system.

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