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Key Health Policies from the Consolidated Appropriations Act of 2026

In early February, Congress passed and the President signed H.R. 7148, the Consolidated Appropriations Act of 2026. While this federal funding bill keeps the government running, it also includes health policy changes that directly affect pharmacies and patients.

Here are the most important provisions for NPhA members to know:

PBM Reform is Now Law

For years, pharmacists have raised concerns about how Pharmacy Benefit Managers (PBMs) operate, especially around spread pricing, hidden fees, and unpredictable reimbursement. The legislation includes the PBM Reform Act of 2025, championed by Rep. Buddy Carter (GA), which makes changes in Medicare Part D to improve transparency, accountability, and oversight.

What is “spread pricing”?

Spread pricing occurs when a PBM charges a health plan one price for a drug, pays the pharmacy a lower amount, and keeps the difference as profit, often without transparency to pharmacies or patients. The new law prohibits spread pricing in Medicare Part D.

What else changed?

• PBM compensation can no longer be tied to a drug’s list price, reducing incentives to favor higher-cost medications.
• PBMs must increase reporting on rebate amounts, pricing structures, and formulary decisions.
• CMS must define and enforce “reasonable and relevant” contract terms, including reimbursement standards, and create an appeals process for pharmacies.
• CMS now has greater authority and funding to monitor payment trends and pharmacy network participation.

Implementation guidance from CMS will determine how these reforms are applied in practice.

Why does this matter to us?

NPhA pharmacists practice across diverse care environments and serve communities where pharmacy access is already fragile. Certain PBM practices have placed disproportionate strain on these communities, contributing to:

• Unpredictable reimbursement
• Retroactive and opaque fees
• Reduced staffing and operational capacity
• Pharmacy closures in urban and rural minority communities

For pharmacists who often serve as one of the most accessible health care providers in their communities, unstable reimbursement threatens business sustainability and community health infrastructure.

PBM reform is intended to increase transparency, create more predictable payment structures, and give pharmacies a clearer pathway to challenge unfair contract terms. For NPhA members, we want to protect the viability of pharmacies in communities that cannot afford to lose them.

Why does this matter to our patients?

When pharmacies struggle, patients feel the impact. Communities of color are more likely to live in pharmacy deserts, rely on Medicaid or Medicare, and face barriers to primary care access.

When local pharmacies close or reduce services, patients experience:

• Longer travel distances for medications
• Delays in care
• Reduced access to clinical services such as chronic disease management
• Fewer vaccinations and preventive care opportunities

Reforming spread pricing and increasing transparency helps protect pharmacy access, medication affordability, and patient choice.

Telehealth Flexibilities Extended Through 2027

The Act also extends Medicare telehealth flexibilities through at least December 31, 2027, providing stability for providers and patients who rely on virtual care, particularly in rural and underserved communities.

Extended provisions include:

• Removal of geographic restrictions (patients may receive telehealth anywhere in the US)
• Continued allowance of the home as an originating site
• Expanded provider eligibility
• Audio-only options for certain mental health services

Why does this matter to us?

Many pharmacists practice in communities with limited primary care access, and virtual care models help bridge those gaps. Telehealth stability supports collaborative care, chronic disease management, and continuity of care in underserved neighborhoods. Maintaining these flexibilities allows pharmacists to continue coordinating care without disruption.

Why does this matter to our patients?

Telehealth allows patients to receive care from home, reduces missed appointments, and supports continuity of care, especially for older adults, working families, and those managing chronic conditions. Maintaining these flexibilities protects access to care in communities where in-person options may be limited or difficult to reach.

Continued Funding for Key Health Programs

These provisions help stabilize federal health programs and ensure continued outreach and support for vulnerable Medicare beneficiaries. The Act also:

• Fully funds the Department of Health and Human Services (HHS)
• Preserves State Health Insurance Assistance Programs (SHIPs), which support Medicare beneficiary education and enrollment
• Maintains Medicare Part D low-income subsidy (LIS) or “Extra Help” cost-sharing protections

Why does this matter to us?

• Stable HHS funding supports regulatory oversight of Medicare and Medicaid programs and public health initiatives serving underserved communities
• SHIP programs reduce coverage confusion that often falls on pharmacists to resolve, and helps patients better understand Part D plans, decreasing billing and enrollment issues at the pharmacy counter
• LIS protections help maintain reimbursement stability for pharmacies serving low-income Medicare beneficiaries and supports medication adherence among vulnerable patient populations

Why does this matter to our patients?

• HHS funding prevents disruption to essential public health and Medicare programs.
• SHIP provides free counseling to help seniors understand coverage and avoid costly enrollment mistakes
• LIS protections reduce out-of-pocket drug costs and improve medication access and adherence for low-income beneficiaries

NPhA Resolutions on PBMs Focus on Transparency and DIR Fees

2023.5 NPhA & SNPhA support the CMS ruling regarding the elimination of retroactive DIR fees charged by Pharmacy Benefit Managers (PBMs), thus increasing transparency for pharmacies and patients.

2023.5 NPhA & SNPhA support the CMS ruling regarding the elimination of retroactive DIR fees charged by Pharmacy Benefit Managers (PBMs), thus increasing transparency for pharmacies and patients.

Resources:

• Full Legislation
• • H.R. 7148 - Consolidated Appropriations Act of 2026
• PBM Reform
• • PBM Reform Act of 2025
  • Buddy Carter PBM Reform Act Press Release
  • Federal Trade Commission: PBM
• Telehealth
• • CMS Telehealth Overview
  • CMS Telehealth FAQs (Updated 2/4/2026)
  • HHS Telehealth Policy Updates
• Health Program Funding
• • HHS Fiscal Year 2026 Budget in Brief
  • SHIP Website & Locator
  • CMS LIS Resources
  • Apply for Medicare Part D Extra Help (LIS) Program

Step Into Advocacy with Us!

• Share your advocacy story with Dr. Chandler Fullington (chandler.fullingotn@npha.net). All stories are welcome, your voice matters!
• Join the NPhA Legislative & Regulatory Affairs Committee

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