This story appears in the September–October 2026 issue of Dispense Times.
As independent pharmacy heads into one of its most consequential legislative stretches in years, Dispense Times sat down with Douglas Hoey, CEO of the National Community Pharmacists Association, to talk about the forces driving federal momentum, the grassroots campaign behind it, and what independent pharmacists can expect at NCPA’s Annual Convention this October in Kansas City.
Between the Pharmacists Fight Back Act clearing the House Oversight Committee and continued traction on Medicare Part D contract reform, it has been a busy year for independent pharmacy advocacy. Add to that a wave of state-level Medicaid payment reform, new PBM audit and enforcement laws, and a grassroots campaign that generated tens of thousands of letters to Congress, and it’s clear independent pharmacy is having a moment on Capitol Hill that’s been years in the making.
We wanted to know what’s actually driving that momentum, how NCPA is turning state-level wins into federal leverage, and what independent pharmacy owners should be watching next. NCPA CEO Douglas Hoey walked us through it — and previewed what attendees can expect at the association’s Annual Convention this October in Kansas City.
The Tipping Point
Dispense Times: With the Pharmacists Fight Back Act clearing the House Oversight Committee, and continued momentum behind Medicare Part D contract reform, what’s driving all of this at the federal level right now?
Hoey: It’s the product of years of work by independent pharmacies and by NCPA carrying that message. But I also think we’ve hit a tipping point. The scale of PBM profiteering has become so obscene that only someone who wasn’t looking could miss it anymore.
Part of that is deliberate. We ran a public awareness campaign — the “PBM Leeches” and “PBM Career Day” spots — that ran in major media markets across the country and reached millions of people. It took years, because this is a genuinely complex issue for the public to grasp. But between the advocacy from independent pharmacy owners, and NCPA’s work, that messaging finally landed with the public. It reached the legislators in a way they could no longer turn away from.
The Grassroots Behind “Finish the Fight”
Dispense Times: NCPA’s “Finish the Fight” campaign generated lots of letters from patients, pharmacy staff and owners to Congress. How did you mobilize that kind of grassroots effort against an opponent with the lobbying resources of PCMA and the major PBMs?
Hoey: Our members have consistently answered the call when we’ve asked for grassroots support — and over the years, the total volume of pharmacy messages to Congress is in the hundreds of thousands. But with “Finish the Fight,” we made a strategic decision a couple of years ago to bring in a voice we hadn’t leaned on enough before: the patient, the consumer.
That’s really what the “PBM Leeches” and “PBM Career Day” spots were built for. Pharmacists and pharmacy owners found them spot-on and funny, but the real goal was reaching patients and consumers directly — helping them understand what’s actually happening with their prescription drug benefit, and getting them as informed and outraged as they should be. That effort alone generated close to 100,000 consumer messages to Congress.
We think bringing the patient’s voice into the fight — and building a real pathway for them to act — was a major contributor to finally seeing results. Congress has taken a first step. We’re pleased with it, but we’re not satisfied. There’s a lot more work ahead on real PBM reform.
Scope of Practice and Pricing Transparency
Dispense Times: Two initiatives seem especially central right now — advancing scope of practice so pharmacists can work and get paid at the top of their license, and pricing transparency through bills like the Main Street Pharmacy Access Act and the Pharmacists Fight Back Act. Why are these so critical to the stability of community pharmacy?
Hoey: The Pharmacists Fight Back Act actually runs on two tracks. One addresses the Federal Employee Health Benefit Program — that’s the piece recently heard in committee. The other has a broader impact. We support both, especially as introduced in this Congress, because they’d bring real reimbursement stability and, importantly for taxpayers, transparency into where our tax dollars are actually going when they flow through these multibillion-dollar PBMs.
For pharmacists, it’s about consistency. Right now, PBMs largely operate however they want, with little recourse for pharmacies. On the Medicare side, we’ve already seen the first PBM reform in the Part D program in its history. That’s given us stability, consistency, and predictability — the three things we keep coming back to. Medicaid reform is the next major priority, and we’re optimistic something could pass this year.
The Main Street Pharmacy Access Act is a little different. Many of the point-of-care testing services it addresses are already technically in place — pharmacists just aren’t getting paid for them through Medicare. So the headline there is that pharmacists would finally start getting paid for services by Medicare. It’s not full provider status, but it’s meaningful recognition of pharmacists as providers.
Given the shortage of primary care and how poorly the U.S. — and frankly the world — handles preventive care, pharmacists are exceptionally well positioned to close that gap. This bill is a first step toward pharmacists doing more of that preventive work: keeping patients out of the hospital, connecting them back to primary care, keeping them on their medications.
If you forced me to name the single most important thing that could happen in the next six months, though, it would be Medicaid reform. That alone would immediately affect something like 15 to 20 percent of the average pharmacy’s business.
Building the Case, State by State
Dispense Times: You work closely with NASPA and state pharmacy associations to build momentum at the state level. What does it mean when a state passes legislation that can then be pointed to as evidence in federal debates?
Hoey: States are simply more nimble than the federal government — I don’t mean they’re easy to work with, but they’re easier to move than what can feel like trying to turn the Titanic in D.C. Partnering with NASPA and state pharmacy groups is critical for that reason.
What we’ve seen is a genuine grassroots-up dynamic. As more states pass legislation, it builds toward a critical mass, and the federal government becomes far more likely to pay attention. Medicaid payment reform is a great example — more than a dozen states, including large ones like California and New York — have already passed it. And notably, those states haven’t seen the cost increases that PBMs love to threaten and fear-monger about.
That track record gives real momentum to the federal push, because instead of asking Congress to take something on faith, we can point to a dozen-plus states where it’s already working. States also function as informal pilot programs — advocates can walk into a member of Congress’s office and say, “this already passed in your state, and here’s what actually happened.” That’s an incredibly powerful reference point.
It’s a lot to ask of our members, who are already running demanding businesses with lives outside the pharmacy. But we need them engaged both federally and in their own backyards.
Following the Evidence on PBM Enforcement
Dispense Times: States have taken different approaches to auditing and enforcement against PBMs, and the FTC has weighed in as well. Do you see this data-driven, enforcement-focused approach as the playbook going forward for holding PBMs accountable?
Hoey: We see it as the beginning of the playbook. Not all state audit laws have been created equal — some are genuinely effective, others lack real enforcement teeth. In some cases, good legislation has passed but simply isn’t enforced, particularly by insurance commissioners, though we are starting to see encouraging signs from some state attorneys general.
The lesson is that legislation needs enforceability and funding behind it, plus genuine appetite among state officials to actually enforce it. PBMs know this, and they’ll often try to water down bills with small language changes — swapping a “shall” for a “may,” for instance — that quietly weakens the effectiveness of otherwise strong legislation.
That said, more states are successfully holding PBMs’ feet to the fire, and taxpayers are increasingly demanding to know where their dollars are going. There’s substantial evidence that PBMs are overcharging the system by hundreds of millions, if not billions, of dollars. There needs to be accountability for that.
What to Expect in Kansas City
Dispense Times: NCPA’s Annual Convention runs October 3–6 in Kansas City. What should attendees look forward to, and what are some highlights you’re planning to share?
Hoey: We’re doing something new this year — we’re calling it our “How To” convention. NCPA has never wanted to be an ivory-tower organization. Our members are the heart and soul of community pharmacy. They’re not looking for fuss and gloss; they want to take care of their patients, make a decent living, and give back to their communities. The “How To” theme reflects that. It’s pragmatic — new and current concepts in pharmacy practice, taught by people who’ve actually gotten their hands dirty doing the work, not just theorizing about it.
A few examples of what attendees will see:
- Practice management and talent — recruiting, hiring, and managing a team. This comes up more than almost anything else in conversations with our members right now.
- Front-end strategy — the average pharmacy is around 3,000 square feet, with roughly 80 percent of that space devoted to the front end, yet it may generate only 5 to 7 percent of total sales. Sessions will dig into how to use that space more effectively and use it to build the pharmacy’s brand.
- LTC at home — for pharmacies already in long-term care at home, or looking to expand into it. Members tell us it’s rewarding from a patient-care standpoint and can meaningfully contribute to the bottom line.
- Cybersecurity — how to lock down your operation. It’s easy to assume no one would target a small independent pharmacy, but if you hold patient data, you’re a target. Unwinding a breach after the fact is not fun.
That’s just four of roughly 25 “How To” topics we’ll cover, including dedicated “How To” stations in the exhibit hall where attendees can get hands-on, small-group time with experts. Our team put together a great concept, and I don’t think this will be the last year we run with this theme.
For anyone who hasn’t been to an NCPA Annual Convention: come experience it. I’ve spent the last couple of years — with mixed success — trying to learn a new language on Duolingo (I’m on a 580-day streak, and it’s genuinely hard). NCPA doesn’t require that kind of effort. We already speak the language of independent pharmacy. We understand you, and when you come to convention, you’re surrounded by thousands of people who speak that same language back to you.
The experience isn’t just the education sessions, the “How To” content, or the exhibit hall — it’s being around your tribe, people who understand exactly what you’re going through, because they’re going through it too. If you haven’t come before, don’t wait. And if it’s been a while, make this the year.
We’ve also moved the meeting earlier this year, ahead of the heart of flu season, and we’ll continue shifting it earlier in future years — likely mid-September going forward. So come out before things get crazy later in the fall.
As one of our longtime members, Jay Phipps, likes to say: you may be an independent pharmacist, but you don’t have to be alone. That’s exactly what attendees will find at the NCPA Annual Convention this October in Kansas City.
NCPA’s Annual Convention runs October 3–6 in Kansas City. For more information on registration and programming, visit NCPA’s website.
