AMAC Action is backing a key set of pharmacy benefit manager (PBM) reforms included in the Consolidated Appropriations Act of 2026, citing the legislation’s potential to lower prescription drug costs, protect seniors, and rein in abusive practices by powerful middlemen in the drug supply chain. The reforms, recently advanced by the U.S. House of Representatives, would bring long-overdue transparency and accountability to Medicare Part D, a program that AMAC members and millions of older Americans rely on.
The Consolidated Appropriations Act of 2026 is Congress’s annual must-pass funding bill that keeps the federal government operating by setting spending levels for agencies and key programs, including Medicare. Because it moves critical funding, the bill is often used to advance targeted policy reforms (like PBM reforms) that have an immediate impact on how federal programs operate.
PBMs were originally created to negotiate lower drug prices on behalf of patients and health plans. Over time, however, they have become profit-driven intermediaries that often inflate costs rather than reduce them. Through opaque pricing arrangements, restrictive pharmacy networks, and compensation models tied to higher drug list prices, PBMs routinely benefit financially while patients and independent pharmacies are left paying the price.
AMAC Action has consistently raised concerns about these practices, particularly within Medicare Part D, where hidden PBM arrangements have driven up out-of-pocket costs for seniors on fixed incomes. The reforms included in the appropriations bill aim to correct these distortions by strengthening federal oversight and restoring market incentives that put patients first.
Specifically, the legislation directs the Centers for Medicare & Medicaid Services to clearly define and enforce reasonable Medicare Part D contract terms while establishing a formal appeals process for pharmacies. It also provides CMS with enforcement authority and implementation funding, ensuring that new protections are meaningful and enforceable rather than merely symbolic.
The bill further enhances transparency by allowing CMS to better track pharmacy payment trends and network participation. This is especially important for preserving access to independent community pharmacies, which play a critical role in rural and underserved areas. Another major provision would prohibit PBMs from tying their compensation to a drug’s list price, a reform known as “delinking.” By removing incentives to favor higher-priced drugs, delinking is expected to help reduce overall prescription drug spending and generate savings for Medicare beneficiaries.
“PBMs have operated behind closed doors for far too long, prioritizing profits over patients,” said Andy Mangione, Senior Vice President of AMAC Action. “These reforms are a strong step toward transparency, accountability, and real savings for seniors who depend on Medicare Part D every day.”
AMAC Action applauds the House for advancing these commonsense reforms and is urging the Senate to ensure robust PBM reform language remains part of any final appropriations package. AMAC will continue advocating for a prescription drug system that works first and foremost for the benefit of patients.
