Tag: Pharmacy Benefit Managers (PBMs)
In brief: Mobility Act clears Senate, PBMs lock in, Reliable Medical buys, AAH surveys
October 2, 2026HME News Staff
WASHINGTON – The Choices for Increased Mobility Act, H.R. 1703, passed the U.S. Senate by unanimous consent on Sept. 30, clearing its final legislative hurdle.
The bill, which will create separate HCPCS codes for manual wheelchair bases made with titanium or carbon fiber and those made without those materials, now heads to the president for his signature, according to AAHomecare.
"This is a tremendous win for Medicare beneficiaries who rely on lightweight mobility technology,"...
AMA analysis: PBM market concentration continues to rise
September 30, 2026HME News Staff
CHICAGO – A small number of pharmacy benefit managers (PBMs) account for an increasingly large share of the national market, according to the American Medical Association’s (AMA) annual analysis.
The top four PBMs collectively had 75% share of the national-level PBM market in 2024, an increase from 70% in 2022, according to the analysis.
“Competitive PBM and prescription drug plan markets help patients get the medications they need at a fair price,” said AMA President...
NCPA makes recommendations to CMS as it seeks to implement PBM reform
July 27, 2026HME News Staff
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...
In brief: Apex Infusion's PE partner, Reliable Respiratory's medical director, NCPA's PBM recs
July 24, 2026HME News Staff
SAN FRANCISCO – Apex Infusion, an omnichannel infusion services provider, has entered into a definitive agreement to partner with SkyKnight Capital, a private equity firm, to drive the company’s next chapter of growth.
Apex's clinician-led management team will retain a significant ownership stake and continue to lead the business. FFL Partners will also remain a minority investor in the company.
“Apex has reached an exciting milestone,” said Rick Smith, executive...
CVS challenges FAIR Rx Act
June 1, 2026HME News Staff
ALEXANDRIA, Va. – Soon after Tennessee Gov. Bill Lee signed into law the FAIR Rx Act, which prohibits pharmacy benefit managers (PBMs) from owning or operating pharmacies, CVS filed a challenge, according to news reports. The National Community Pharmacists Association (NCPA) noted that CVS, Express Scripts, the Pharmaceutical Care Management Association (PCMA) and others have also filed a lawsuit challenging a similar law passed in Arkansas. The NCPA joined the Arkansas Pharmacists Association...
NCPA celebrates PBM bill passing in Tennessee
May 26, 2026HME News Staff
ALEXANDRIA, Va. – The National Community Pharmacists Association (NCPA) applauds Tennessee Gov. Bill Lee for signing the Freedom, Access and Integrity in Registered Pharmacy (FAIR Rx) Act (Senate Bill 2040/House Bill 1959) into law, making the state the second to pass legislation prohibiting pharmacy benefit managers (PBMs) from owning or operating pharmacies. The NCPA supported the Tennessee Pharmacists Association’s leadership on the FAIR Rx Act as it moved through the legislative process....
In brief: Scam prevention, PBM protection, Accendra offer
May 22, 2026HME News Staff
WASHINGTON – Rep. Aaron Bean, R-Fla., has introduced H.R. 8871, the DME Scammer Prevention Act, to require the electronic submission of DME products most susceptible to fraud within 90 days of the initial claim date. The current submission deadline is 365 days, which Bean says allows fraudulent vendors to take advantage of the payment system. “Rising fraud and criminal activity threaten to undermine the Medicare system for Northeast Floridians and seniors across the country,” he...
NCPA, NGA join new coalition to support small businesses
May 18, 2026HME News Staff
ALEXANDRIA, Va. – The National Community Pharmacists Association (NCPA) and the National Grocers Association (NGA) joined the newly-formed Main Street Competition Coalition at a kick-off event in Washington, D.C., to rally small business organizations across the spectrum against big corporations that they say use their market dominance to squeeze out smaller competitors. The Main Street Competition Coalition is a nonpartisan coalition of independent businesses fighting to restore competitive...
NCPA supports re-introduction of Monopolies Act
May 18, 2026HME News Staff
ALEXANDRIA, Va. – The National Community Pharmacists Association (NCPA) supports the re-introduction of the Patients Before Monopolies Act, which would force companies that own health insurers or pharmacy benefit managers to divest their pharmacy businesses within three years. The act, first introduced in December 2024, has been reintroduced in both the House and Senate. “PBMs have a choice – operate as a PBM or operate as a pharmacy, but you can’t have it both ways,”...
NCPA hits Hill, asking lawmakers to address PBM practices in gov’t programs
April 20, 2026HME News Staff
ALEXANDRIA, Va. – Independent pharmacists visited nearly 300 offices for meetings with lawmakers and their staff during the National Community Pharmacist Association’s Congressional Pharmacy Fly-In on April 15-16. Their message: We appreciate the reforms to Medicare Part D contract terms that Congress passed earlier this year, and now we would urge them to address pharmacy benefit manager practices in government programs like Medicaid, Tricare, and the Federal Employee Health Benefit...