Medicaid Changes
Loren Bonner
Maybe you’ve heard of it? The One Big Beautiful Bill Act is well known for how it could reduce federal Medicaid spending. As a reconciliation bill—meaning it deals with spending, revenue, and the federal debt—Congress is allowed to pass one of these bills per year.
Since the bill mandates more frequent Medicaid eligibility redeterminations and imposes Medicaid work requirements, the concern is that many patients will lose their Medicaid coverage.
“Pharmacies are often the first point of contact where patients learn they have lost Medicaid coverage—typically at the pharmacy counter—creating confusion, increasing administrative burdens, and disrupting access to medications,” wrote APhA in its June 27, 2025, Legislative and Regulatory Update newsletter.
Pharmacists are one of the only health care providers who will need to explain to patients why their prescribed medications are no longer covered under Medicaid.
At a recent meeting for the Association of Health Care Journalists in Los Angeles, Rachel Nuzum, vice president for policy at the Commonwealth Fund, said that recent polling showed that 40% of voters don’t know that the House bill includes Medicaid cuts—if they know about the bill.
Other hidden provisions
One threat to community pharmacies, especially those in rural and underserved areas, is the provision in the bill for mandatory participation in the national average drug acquisition cost (NADAC) survey. Given the removal of the Medicaid managed care spread pricing provision within the reconciliation bill, APhA noted that the mandatory NADAC reporting provision also needs to be removed since mandatory NADAC reporting, without a commensurate professional dispensing fee requirement, will lower reimbursements to pharmacies—leading pharmacies to be paid even more below cost than they are currently.
A similar proposal is setting off alarm bells in Ohio. When the $10 dispensing fee to all prescriptions was scrubbed from a measure, but NADAC language was left intact, Dave Burke, executive director of Ohio Pharmacists Association, said in a news article that “You can’t buy ingredients for a dollar and sell pizzas for a dollar and stay in business,” alluding to the other costs—staff, space, and equipment—required to fill prescriptions. “It’s any pharmacist’s suicide bill... If pharmacies can’t make any money—this legislation makes it so that you’re not making any money at all—it would probably force the closure of the overwhelming majority of pharmacies in this state,” he told the Ohio Capital Journal on June 27, 2025.
APhA noted that as long as NADAC is paired with the state’s dispensing fee, it keeps community pharmacies viable.
What else?
The reconciliation bill does take notable steps to rein in the anticompetitive practices of PBMs by prohibiting spread pricing in Medicaid-managed care and delinking PBM profits from prescription drug prices. Additionally, it requires transparent and fair reimbursement (Medicaid fee-for-service rate) in all state Medicaid-managed care programs, beginning 18 months after enactment.
APhA said these provisions would help to stabilize the pharmacy business model and prevent more pharmacies from closing their doors. ■
ACIP changes
When HHS removed all 17 CDC ACIP voting members from the vaccine recommendation panel, APhA said in a statement that the move has “dire consequences” for objective nonpartisan representation on ACIP.
“APhA strongly urges that the voting membership of ACIP be comprised of scientists, researchers, and clinicians—including pharmacists—who possess the clinical and scientific acumen to provide evidence-based recommendations for vaccines, in a nonpartisan manner,” APhA said.
Visit apha.us/VaccineRecommendations to learn more about the change from Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP, executive vice president and CEO of APhA. ■