On February 3, 2026, President Trump signed the Consolidated Appropriations Act (CAA) 2026 into law, and the pharmacy trade press correctly treated it as the most significant federal pharmacy benefit manager (PBM) legislation in years.1 Six months later, the headlines have mostly moved on. That is a mistake for any independent pharmacy trying to plan its next few years, because the law’s real effects have not started yet, and the gap between passage and implementation is exactly when the groundwork for compliance and negotiation actually gets laid.
What To Do With the Runway Between Now and 2028
- Request current rebate and fee data from your PSAO or PBM now, even though disclosure requirements are not yet mandatory, so you have a baseline to compare against once transparency reporting begins.
- Review existing PBM contract language for bonafide service fee definitions, since this term will determine what PBMs can still be paid for after delinking takes effect.
- Flagany contract renewal or renegotiation between now and 2028 as an opportunity to build in the transparency terms the CAA will eventually require anyway.
- Watch for CMS and Department of Labor rule making, since both agencies are actively drafting the implementation rules that will define how these provisions actually apply.
What the Law Actually Changes
The CAA 2026 focuses on 2 areas: Medicare Part D pharmacy benefit administration and employer-sponsored health plans governed by Employee Retirement Income Security Act (ERISA).2 For Part D, the law introduces “delinking,” separating PBM compensation from the price of a drug and from rebate volume. Instead of earning more by favoring higher-priced drugs, PBMs will be limited to bonafide service fees, defined as fair market value payment for an itemized service actually performed, not passed through to a client.3 For the commercial ERISA market, the law imposes mandatory transparency and 100% rebate pass-through requirements.2
CMS also received a substantial enforcement boost, close to $190 million in new funding, giving the agency authority to arbitrate PBM-pharmacy disputes, oversee rebate pass-through compliance, and audit fee structures across the supply chain.4 That enforcement capacity did not exist at this scale before this law.
The Timeline Is Longer Than the Headlines Suggested
Here is the detail that matters most for independent pharmacies planning their next few years: Most CAA 2026 provisions do not take effect until plan years beginning on or after August 3, 2028, or January 1, 2029 for calendar-year plans.5 This is not a law that changed pharmacy reimbursement overnight. It is a law that set a deadline still more than two years out as of this writing.
That gap between passage and effect is not empty time. PBMs are already restructuring internally, revisiting contracts with employers and unions, and building the reporting systems the law will require.6 Independent pharmacies that treat 2028 as a distant deadline rather than an active planning window will find themselves negotiating from a weaker position when it arrives.
What Independent Pharmacies Should Actually Do Now
Request data early, even though it is not required yet. PBMs are already passing through approximately 99.6% of rebates to Part D plans and more than 90% to employers according to industry-reported figures, but that voluntary disclosure varies significantly by PBM and by contract.6 Asking now establishes a documented baseline before the law forces standardized reporting.
Read the bonafide service fee language in current contracts closely. This single definition, what counts as a fee for an actual service performed, is where the real fight over PBM compensation will play out once rebate-linked pay is off the table. A loosely defined bona fide service fee is functionally a new version of the same misaligned incentive the law is trying to eliminate.
Treat every contract renewal between now and 2028 as leverage, not just as business as usual. Any pharmacy renegotiating with a PBM in the next 2 years has a real opportunity to build in the transparency and pass-through terms the CAA will eventually mandate, ahead of the deadline, rather than waiting to be forced into compliance.
Watch the rule making process directly. The Department of Labor has already released proposed rules overlapping with and expanding on the CAA's transparency and disclosure requirements, and CMS will do the same for the Part D side.7 These implementation rules, not the statute itself, will determine exactly how delinking and pass-through requirements apply in practice.
The Runway Is the Opportunity
About the Author
Mohammed Chammout, PharmD, BCMTMS, is a Clinical Access and Reimbursement Specialist and founder of MKC Strategic Solutions, a consulting practice focused on specialty drug access, benefit verification, and PBM policy. He also serves on the Dispense Times Editorial Advisory Board.
Six months after passage, PBM trade groups are already framing the CAA 2026 as a settled, incremental step, noting that rebate pass-through rates were already high before the law required them.6 That framing undersells what changes once bona fide service fee definitions, CMS enforcement authority, and mandatory standardized reporting are all live simultaneously in 2028 and 2029.
Independent pharmacies that spend the next 2 years building documentation, watching rule making, and pressing for transparency terms in every contract renewal will be the ones positioned to benefit when the deadline finally arrives.
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