The National Association of Chain Drug Stores (NACDS) today commended the inclusion of vital Medicaid pharmacy benefit manager (PBM) middleman reforms in draft reconciliation legislation. If enacted, these broadly supported reforms would represent a significant victory for increased transparency and fairness in Medicaid managed care pharmacy reimbursement while banning the costly practice of spread pricing that has jeopardized patient access and driven up prescription drug costs for Americans.
“NACDS is pleased to see essential Medicaid PBM reforms included in this bill text,” said NACDS President and CEO Steven C. Anderson. “This is a decisive move to begin to confront the harmful practices of PBM middlemen that have inflated drug prices, restricted patient choice, and shuttered pharmacies. NACDS thanks the members of Congress on both sides of the aisle who have continued to press for immediate action.”
The Medicaid PBM reform provisions in the bill require 100% pass-through to pharmacies of ingredient costs and professional dispensing fees — a shift with the power to save the federal government and states billions of dollars. These measures also guarantee that Medicaid managed care pharmacy reimbursement from PBMs will cover the true cost of acquiring and dispensing prescription medications, strengthening the sustainability of pharmacy care nationwide.
The urgency of PBM reform is clear. NACDS has compiled data revealing that pharmacies are closing at a rate of 3.7 per day, with more than 5,800 closures since 2018 and 1,364 in 2024 alone. These closures have left over 800 ZIP codes in the United States without ready pharmacy access, creating real pharmacy deserts and jeopardizing essential healthcare services in communities nationwide.
“The costs of inaction on comprehensive PBM reform are massive and growing, all while the PBMs report record revenues,” Anderson said. “PBMs are forcing pharmacies to fill prescriptions at a loss while inflating Americans’ medication costs. By enacting these Medicaid PBM reforms, Congress would finally take a stand against the unchecked abuse that PBMs have imposed for far too long, and PBM reforms within the Medicare program are just as urgent.”
