Frier Levitt Partner Jesse Dresser recently spoke with The American Journal of Managed Care (AJMC) about significant legislative and regulatory developments that could reshape how specialty pharmacies contract with pharmacy benefit managers (PBMs) and are reimbursed for their services. The interview took place during the National Association of Specialty Pharmacy’s (NASP) inSPire 2026 conference, where Dresser presented on the evolving payor landscape and contracting frameworks affecting specialty pharmacies.
The interview explored the federal requirement that PBM contract terms and conditions offered to pharmacies be “reasonable and relevant,” including the Centers for Medicare & Medicaid Services’ (CMS) role in further defining that standard and the importance of specialty pharmacy participation in the regulatory process. Dresser also highlighted the shift toward cost-plus reimbursement models and the risk that approaches designed for traditional retail pharmacies may not adequately account for the clinical services and operational costs associated with specialty medications.
