Independent pharmacies continue to face significant financial pressures from pharmacy benefit manager (PBM) reimbursement practices, with emerging cost-plus contracting models introducing new challenges. In a recent interview with Drug Topics during the 2026 National Community Pharmacists Association (NCPA) Annual Convention, Frier Levitt attorney A.J. Barbarito discussed the evolving reimbursement landscape and the implications for community pharmacies heading into 2027.
A.J. highlighted longstanding concerns surrounding below-cost reimbursement, opaque maximum allowable cost (MAC) pricing, and the administrative burden of challenging underpaid claims. He also examined the potential risks associated with cost-plus reimbursement models, including demands for confidential wholesaler purchasing data, inadequate dispensing fees, and contract structures that may further erode pharmacy margins. As federal and state regulators pursue PBM reform, A.J. emphasized the importance of carefully evaluating reimbursement terms and understanding how proposed changes could affect pharmacies’ financial sustainability.
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