For years, small business pharmacies have withstood oppressive PBM anti-competitive practices and other market forces that have pushed otherwise larger legacy pharmacies to the brink of closure. Still, in 2026 there are fewer independent pharmacies left to serve the growing ranks of patients needing access to affordable medication and care. There are also fewer advocates left to fight for you, your business and the pharmacy profession.
Your profession needs you – the person reading this missive – to join this critical fight, and we’ve outlined what we see are the major initiatives to fight for in 2026:
H.R. 6609 and H.R. 6610: The Pharmacists Fight Back Act
Representatives Jake Auchincloss (D-MA), Diana Harshbarger (R-TN) and Chairman James Comer (R-KY) introduced H.R. 6609 and H.R. 6610, collectively called the Pharmacists Fight Back Act (PFBA) last month at a Capitol Hill news conference that was attended by 55 pharmacists from 22 states.
The reforms introduced in these bills apply to the federally-funded Medicaid and Medicare (H.R. 6609) and Federal Employees Health Benefits Plan employees and retirees (H.R. 6610), but they model legislation that should be introduced at the state level, including NADAC-indexed reimbursement plus state Medicaid dispensing fee as determined by CMS; and 4 percent, not-to-exceed-$50 margin per prescription. The PFBA includes several other reforms including a prohibition on patient steering and criminal penalties for violating the law. Our goal in 2026 is to see the PFBA cross the finish line to a floor vote and enactment.
How You Can Help: Contact your Congressional representatives and ask them to cosponsor H.R. 6609 and H.R. 6610. If your state or national pharmacy organization is advocating for PFBA, join and actively participate in their campaign. Better yet, join Pharmacists United for Truth and Transparency (PUTT)’s PFBA Working Group (you don’t have to be a PUTT member to join PUTT project groups).
Audit TRICARE, Audit Express Scripts
A few years ago TRICARE patients and their community pharmacies of choice were given a raw deal when Express Scripts issued new contracts with untenable terms. Most pharmacies couldn’t afford to stay in the TRICARE network and now we know why: Prices posted on TRICARE’s patient portal for the most commonly prescribed generic medications strongly suggest Express Scripts has been taking advantage of TRICARE enrollees and the federal government.
PUTT wasn’t the first to call for an independent audit of TRICARE, but our interactive U.S. map demonstrating 50+ ways TRICARE enrollees are better off NOT using their benefits has captured national attention and renewed vigorous calls for an independent audit.
How You Can Help: Review AuditTricare.org, then share your pharmacy’s TRICARE experiences with your state and federal elected officials, including if your pharmacy was forced to drop the TRICARE contract because of impossible reimbursement terms. Sign our petition demanding an audit, and ask your patients to sign the petition and share their stories.
End the “Commoditization of Pharmacy”
From PUTT’s perspective, PBMs have spent years commoditizing pharmacy, treating our profession as a simple transaction rather than the clinical relationship it is. When narrow networks force patients away from their trusted pharmacists, when prior authorization requirements delay care, and when reimbursement pressures prevent adequate counseling time, patients suffer.
How You Can Help: Share what you do and share your pharmacy’s story – everywhere, all the time. Ask your patients to do the same. Pharmacists are medical professionals who take an oath of care. It should go without saying that counseling patients for drug interactions or easing side effects is not in the same category as buying paper towels, but here we are. We can use the same tools PBMs use to diminish pharmacy to take back our professional image.
Demand Transparency in Emerging Distribution Models
A disturbing new trend in manufacturers selling prescription medication direct-to-consumer (DTC), seemingly endorsed by the White House, has us asking if the President who promised to end “greedy middlemen” got his middlemen confused. DTC programs conveniently bypass the pharmacists – those who’ve bravely and reliably called out the PBMs and other questionable parties, providing data-backed evidence of spread pricing, patient steering, withholding rebates and other price-gouging revenue schemes.
How You Can Help: Ask questions. Speak out. Report concerning patterns to state boards of pharmacy and to your representatives. Pharmacies are held to strict standards of professionalism in the interest of patient safety. Advocate for these same regulations requiring DTC programs meet the same safety, quality, and transparency standards that traditional pharmacies must meet.
This Is the Year
The opportunities in 2026 are real but not guaranteed. We can attest that every significant victory for independent pharmacy has come because pharmacists refused to be silent.
We believe 2026 can be the turning point—the year independent pharmacy fought back and won. But only if we work together to treat these priorities with the urgency they deserve.
PUTT is already at work on these priorities. We invite you to join us. Make 2026 count.
The future of independent pharmacy depends on what we do right now.
Monique Whitney is Executive Director of Pharmacists United for Truth and Transparency. Pharmacists United for Truth and Transparency is a national organization dedicated to advocating for fair pharmacy practices, transparent PBM operations, and policies that protect patient access to care.
