Arthritis Patients Benefit From PBM Reforms in the 2026 Federal Spending Law

Feb. 12, 2026  

Most people have never heard of pharmacy benefit managers (PBMs), and that’s not surprising, as their role is typically behind-the-scenes. PBMs are companies that sit between your health insurance plan, your pharmacy and drug manufacturers, helping decide which medicines are covered, how much they cost and how easy they are to get. For years, this role has been largely invisible to patients, even as many people with arthritis have faced high out-of-pocket costs, coverage hurdles and sudden changes to medications.  

In February 2026, Congress took a major step to set rules for how PBMs operate, a change that could affect medication costs, access to treatment and the stability of coverage. The Arthritis Foundation has worked closely with policymakers over the years, bringing patient voices into conversations about PBM reform and highlighting the real-world impact these practices have on health care access and affordability. This milestone represents nearly a decade of collaborative, bipartisan work to advance PBM reforms, and it signals a new era of greater transparency in PBM practices. 

Key Reforms Now Law as Part of the Consolidated Appropriations Act of 2026 

Signed into law on Feb 3, the Consolidated Appropriations Act of 2026 now requires PBMs to pass 100% of every rebate, discount and fee they get from drug companies straight through to employers and health plans. The full pass-through rule will start for any new or renewed PBM contract 30 months after enactment, which will be around August 2028. For people managing chronic illnesses, this means that the money PBMs negotiate on your behalf is more likely to reach your insurance plan, helping lower what you pay for medicines. 

Additionally, starting January 2028, Medicare Part D will put new rules in place to make PBMs more transparent and reduce conflicts of interest. PBMs will no longer be paid based on drug prices or rebates, and they will have to report detailed information about spending and rebates to the government and insurance plans. These changes are designed to make sure PBMs don’t push higher-cost drugs for their own profit, which could help lower out-of-pocket costs and make medicines more affordable. 

These reforms are also a testament to the dedication of Arthritis Foundation Advocates, whose voices and stories helped shape this change and put patient needs at the center of PBM reform. The Arthritis Foundation will continue to monitor federal implementation and the rulemaking process to ensure these reforms deliver real value to the arthritis community.