As health plans, employers, and pharmacy stakeholders prepare for 2027, evolving pharmacy benefit manager (PBM) regulations, Medicare Advantage plan exits, and proposed changes to the 340B Drug Pricing Program are creating new challenges for prescription drug affordability and patient access. In an article by The American Journal of Managed Care (AJMC), these developments are examined alongside new PBM transparency requirements under the Consolidated Appropriations Act of 2026, challenges facing Medicare beneficiaries, and the potential impact of rising healthcare costs on medication adherence.
A.J. Barbarito provided insight into the legal, financial, and operational implications of these changes. He emphasized that increased PBM transparency will place greater responsibility on plan fiduciaries to use newly available pricing and claims information to benefit plan members. He also warned that Medicare Advantage plan exits and the proposed 340B rebate model could restrict pharmacy choice, increase administrative burdens, and disrupt access to medications. Health plans should consider negotiating arrangements that allow patients’ lower-cost prescription purchases to count toward their deductibles and out-of-pocket maximums. Looking ahead, PBM oversight is expected to remain a bipartisan priority, while the PBMs may adapt their business models to preserve profitability despite regulatory reforms.
Senior Associate
