Sweeping PBM Reforms Arrive: What The 2026 Federal Legislation Means For Pharmacies, Patients And Employers

On February 3, 2026, Congress enacted the Consolidated Appropriations Act, 2026, marking a watershed moment in the regulation of pharmacy benefit managers (PBMs). With the passage of United States House Bill 7148, incorporating robust PBM reform language crafted in collaboration with the Senate Finance Committee, the federal government has taken a decisive step toward increasing transparency, accountability and fairness in the prescription drug supply chain. These reforms promise to reshape the landscape for employer health plans, independent pharmacies and, most importantly, patients across the country.

Any Willing Pharmacy Law: Expanding Patient Choice

The new legislation also introduces a robust "Any Willing Pharmacy" provision. Starting in 2028, prescription drug plan sponsors must allow any pharmacy meeting standard contract terms and conditions to participate in their networks. This opens the door for independent and community pharmacies to serve more patients without facing exclusionary barriers. In addition, the bill establishes a new category of "essential retail pharmacies," specifically recognizing those in rural, underserved or urban areas with limited pharmacy access. The Secretary of Health and Human Services (HHS) will publish a list of these essential pharmacies and provide ongoing reports on their participation and reimbursement trends, ensuring greater visibility and support for pharmacies serving vulnerable populations.

PBM Compensation Reform

One of the most significant changes takes effect in 2028: Medicare Part D plans will be required to compensate PBMs solely through flat, bona fide service fees, payments that reflect fair-market value for actual services performed. By restricting remuneration to fixed-dollar amounts, the legislation aims to eliminate the perverse incentives created by rebate-linked compensation structures. This move is designed to curb the preference for high-list-price drugs to lower costs for patients and payers.

PBM Transparency: Detailed Reporting and New Protections

Transparency is at the heart of the new federal reforms. PBMs must now provide employer health plans with detailed, semiannual reports on net drug spending, rebates and "spread pricing" arrangements. These reports will also explain benefit designs that may steer patients toward PBM-affiliated pharmacies, arming employers and plan sponsors with critical information to evaluate the true value of their pharmacy benefit. Importantly, pharmacies now have a formal process to report contract violations by PBMs, with new protections against retaliation and explicit penalties for noncompliance, empowering pharmacists to advocate for fair treatment without fear of reprisal.

In addition, a critical component of the new PBM reform is the enhanced right of audit granted to prescription drug plan (PDP) sponsors. At least once per year, upon request, PBMs must permit a comprehensive audit to verify compliance with all terms and conditions set forth in their written agreements and to confirm the accuracy of required transparency reporting. PBMs are obligated to provide auditors with access to all relevant records, data, contracts and supporting documentation, including information held by any PBM affiliates. While these disclosures are subject to reasonable safeguards to prevent inappropriate redisclosure, the new requirements ensure that PDP sponsors have the tools necessary to independently validate PBM practices and reporting. This annual audit right marks a significant step forward in promoting transparency, accuracy and accountability.

What Comes Next?

These changes represent a broader federal crackdown on opaque PBM business practices. While some provisions are already in effect, others will roll out over the next several years, culminating in a more transparent, competitive and patient-focused pharmacy benefit system. The recent release of legislative text for a government funding bill in the U.S. House of Representatives — which includes substantial PBM reform language negotiated with the Senate Finance Committee — represents a critical step forward for patients and independent pharmacies nationwide. For employers, independent pharmacies and patients, the reforms signal a new era of choice, fairness and accountability.

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