PBM Reforms and Tax Benefits Impacting Pharmacies in 2026

The Consolidated Appropriations Act of 2026 (H.R. 7148) brings significant changes for pharmacies, encompassing both pharmacy benefit manager (PBM) reforms and updated tax benefits. These changes, finalized on February 3, 2026, and signed into law by President Donald J. Trump, aim to increase transparency, improve pharmacy access, and offer financial incentives for investment. This article details the key provisions impacting pharmacy operations.

PBM Reforms: A Landmark Shift

For nearly two decades, Medicare Part D has lacked major PBM reform. The 2026 CAA addresses this, drawing from the PBM Reform Act of 2025 and other legislative proposals. These reforms will significantly reshape PBM operations across both the commercial market and Medicare Part D, with the most substantial changes taking effect between 2028 and 2029. The core focus is on rebate pass-through, increased transparency, standardized reporting, and expanded federal oversight. National Law Review

The reforms are a response to concerns about PBMs inflating prescription drug costs, contributing to pharmacy closures, and limiting patient access to preferred pharmacies. Organizations like the National Community Pharmacists Association (NCPA), the National Association of Chain Drug Stores, and the American Pharmacists Association have applauded the introduction and passage of these reforms. NCPA

Tax Benefits for Pharmacy Investments

A key incentive for pharmacies is the re-proposal of hyper-depreciation for investments made in 2026, 2027, and through September 30, 2028. This benefit applies to new Industry 4.0 capital goods produced in an EU or EEA state and allows for increasing the purchase cost of the asset by 180% for depreciation purposes (or leasing fees) when calculating income taxes. This does not apply to the IRAP tax.

The 180% rate applies to investments up to €2.5 million, decreasing to 100% for investments between €2.5 million and €10 million, and 50% for investments exceeding €10 million up to €20 million. Given that most Italian pharmacies are micro or small businesses, the 180% rate is expected to be the most relevant for the majority.

Specific areas of interest for investment include vending machines and robotic warehouses. The tax savings from depreciation and hyper-amortization could potentially cover the entire financial outlay of these investments. However, pharmacies should consider the lifespan and potential obsolescence of machinery, particularly robotic warehouses, which represent a significant expense and operational commitment.

Additional Tax Law Changes Affecting Pharmacies

Several other tax law changes will impact pharmacies:

• Meal Vouchers: The daily non-competition threshold for employee income electronic meal vouchers increases from €8 to €10 in 2026. The tax exemption threshold for paper meal vouchers remains at €4.
• Flat Tax Regime: The enhanced income threshold of €35,000 relating to employment and pension income is extended to 2026 for those applying the flat rate regime. This is relevant as more pharmacists opt for a VAT number instead of traditional employment.
• Equity Investment Taxation: The substitute tax due for the revaluation of the purchase cost of equity investments by natural persons, companies, and associations increases from 18% to 21% in 2026, making the transfer of company shares more expensive. However, the substitute tax for land revaluation remains at 18%.

Looking Ahead

The 2026 CAA represents a significant step towards addressing long-standing issues within the pharmacy landscape. Pharmacies should carefully evaluate the PBM reforms and tax benefits to optimize their operations and financial planning. Healthcare organizations should anticipate downstream funding and policy developments as they develop advocacy initiatives for federal FY 2027 bills. Health Management