PFCD Celebrates Passage of PBM Reforms Critical to Lowering Costs and Improving Outcomes for Americans with Chronic Disease

February 4, 2026 (WASHINGTON, D.C.) The Partnership to Fight Chronic Disease (PFCD) applauds the passage of the Consolidated Appropriations Act of 2026 and its inclusion of many important health care elements that support efforts to better prevent and manage costly chronic conditions. Notably, the bill will increase transparency and lower health care costs for people living with one or more chronic conditions by instituting much needed reforms for pharmacy benefit managers (PBMs) in both Medicare Part D and the commercial market. This represents an important first step toward holding PBMs accountable, protecting patient access, and improving the affordability of prescribed medications.

More specifically, the PBM reforms included in this package would:

• Require Part D plans to contract with any pharmacy that meets reasonable, relevant standard terms, with HHS directed to define and enforce those standards beginning in 2029.

• Limit PBM compensation in Part D to flat, bona fide service fees, fully delinked from drug prices, formularies, and utilization, while passing through rebates and discounts.

• Mandate comprehensive PBM reporting in Part D on drug utilization, pricing, rebates, retained compensation, and PBM-owned pharmacy activity starting in 2028.

• Bar PBM contracts that restrict disclosure or reporting, ensuring access to financial and utilization data across the commercial market.

• Require regular, drug-level reporting to federal agencies on pricing, compensation, rebates, and benefit designs that steer patients to PBM-affiliated pharmacies for PBMs in the commercial market.

• Require PBMs serving ERISA plans to pass through 100% of rebates and related payments to the issuer, grant audit rights, and strengthen fee and rebate disclosure.

The new law also enables better prevention and early detection of cancer by allowing Medicare to cover cutting-edge multi-cancer diagnostics that can detect multiple cancers from a single blood test. Other important provisions in this legislation that aim to advance the fight against chronic disease focus on improving access to care across Medicare and rural communities, funding research for cancer and Alzheimer’s and supporting mental health services.

PFCD stands ready to engage with the Administration as relevant agencies work to implement this legislation. We call upon Congress to continue to pursue bipartisan, patient-centered reforms to PBM and health plan behaviors that inhibit access and affordability for the millions of U.S. individuals and families managing chronic conditions.