Home Article NCPA makes recommendations to CMS as it seeks to implement PBM reform

NCPA makes recommendations to CMS as it seeks to implement PBM reform

By HME News Staff

Updated 11:14 AM CDT, Mon July 27, 2026

Douglas Hoey ALEXANDRIA, Va. – The National Community Pharmacists Association (NCPA) has sent a letter to the Centers for Medicare & Medicaid Services (CMS) responding to the agency’s request for information on the pharmacy benefit manager reform passed earlier this year. In its letter, NCPA focused on three key questions: what is a PBM and a PBM affiliate, how should PBMs be paid, and how should independent community and long-term care pharmacies be reimbursed? “The rulemaking process is critical because that’s where the rubber meets the road,” said NCPA CEO B. Douglas Hoey. “CMS is writing the rules that will implement what Congress intended when it passed PBM reform. We know the PBMs will try to have loopholes inserted into the rules, so we are working with CMS to ensure the rules are clear and tight.” The NCPA also urged CMS to clarify that PBMs must reimburse independent pharmacies for their cost of acquiring the drugs, plus a dispensing fee based on objective data, plus a fee for pharmacist-provided professional services. Pharmacy reimbursements are currently based on whatever PBMs claim they should be, based on criteria the PBMs do their best to hide or obscure, the NCPA says. “This is a chance to restore PBMs to their original purpose, which is to help make the prescription payments easier for employers, unions, and patients,” said Hoey. “They were never intended to control every aspect of patient care, including overruling the medical decisions of doctors and pharmacists.”