PBM Reform Becomes Law, Strengthening Louisiana’s Fight for Lower Drug Costs and Patient Access

For years, Louisiana patients and independent pharmacies have warned that pharmacy benefit managers (PBMs) are driving up prescription drug costs while quietly squeezing community providers out of the health care system. Last week, Congress took a meaningful step to address those concerns—and Louisiana leaders are positioned to build on that progress.

President Donald Trump signed the Consolidated Appropriations Act, 2026, which includes major PBM reform provisions authored by Rep. Buddy Carter, a pharmacist and long-time advocate for patients and local pharmacies. The reforms represent the most significant federal action on PBM oversight in decades and arrive as Louisiana intensifies its own efforts to rein in abusive PBM practices.

PBMs operate as middlemen between insurers, drug manufacturers, and pharmacies, yet their business model has long relied on opaque pricing structures, spread pricing, and restrictive pharmacy networks. In Louisiana, these practices have contributed to higher out-of-pocket costs for patients and forced the closure of independent pharmacies, particularly in rural and underserved communities where local pharmacies often serve as the primary access point for care.

The impact is especially acute in a state that consistently ranks among the highest in the nation for chronic disease, including diabetes, heart disease, and cancer. Reliable and affordable access to prescription medications is not optional for Louisiana families—it is essential. Recognizing that reality, Governor Jeff Landry has made PBM reform a priority at the state level, backing efforts to increase transparency, protect community pharmacies, and ensure patients are not caught in the middle of opaque corporate arrangements.

The federal reforms signed into law strengthen Louisiana’s ability to deliver meaningful relief. Under the new law, PBMs and their affiliates are prohibited from earning compensation tied to the price of drugs under Medicare Part D, targeting incentives that reward higher list prices rather than affordability—an issue that disproportionately affects Louisiana seniors. PBMs must also clearly define and consistently apply drug pricing terms in contracts with plan sponsors and submit annual reports detailing pricing and rebate information, restoring a measure of transparency to a system that has long operated behind closed doors.

Importantly, these reforms reflect a more sustainable and targeted approach to lowering drug costs than blunt pricing mandates like “most favored nation” (MFN) proposals. While MFN attempts to import foreign price controls into the U.S. market, PBM reform addresses the domestic drivers of inflated costs by fixing the incentives and middleman practices that distort pricing in the first place. By focusing on transparency, competition, and accountability, PBM reform delivers relief without risking reduced access, supply disruptions, or long-term market instability.

Medicare Part D plan sponsors are granted new audit rights over PBMs, improving oversight and reducing information imbalances that have historically favored PBMs over employers, states, and patients. The law further extends transparency requirements to employer-sponsored health plans, mandating semi-annual disclosures on prescription drug spending, rebates, spread pricing arrangements, and formulary decisions—data that could prove especially valuable for Louisiana’s small and mid-sized businesses facing rising health care costs.

Importantly for Louisiana’s community pharmacies, the law requires that beginning in 2029, Medicare Part D plans allow any willing pharmacy that meets standardized, reasonable contract terms to participate in plan networks. It also establishes a new category of “essential retail pharmacies” in underserved areas and mandates regular federal reporting on reimbursement levels, network participation, and patient cost sharing. Pharmacies are given a formal pathway to report contract violations without fear of retaliation, with enforcement authority and penalties for noncompliance.

Together, these federal reforms complement Governor Landry’s ongoing efforts to hold PBMs accountable at the state level and preserve access to care for Louisiana patients. By increasing transparency, limiting perverse pricing incentives, and protecting independent pharmacies, policymakers in Washington and Baton Rouge are aligning around a shared goal: ensuring that prescription drug benefits serve patients—not middlemen.

While further reforms may be necessary, the combination of federal action and Louisiana leadership marks a turning point in the fight to lower drug costs and strengthen access to care across the state.