The 2026 midterm elections are reshaping Washington, and for independent pharmacy, the next several months could be especially important.
As of Wednesday morning, Democrats are projected to take control of both the House and Senate when the new Congress convenes in January. News networks project Democrats have currently secured at least 54 Senate seats, although two races remain unresolved, while Democrats have also secured control of the House with many races still being counted.
This sets up a significant change in Washington with divided branches of government, a Democratic control of Congress alongside Republican President.
For independent pharmacy owners and pharmacists, however, the most important question is not which party controls Washington. It is whether the next Congress will continue addressing the reimbursement, PBM and patient-access challenges threatening community pharmacies.
First Comes the Lame-Duck Session
Before the new Congress takes office, lawmakers still have work to do.
IPC has been closely monitoring several pharmacy priorities that could move as part of year-end legislation, including Medicaid managed care pharmacy reform, the Main Street Pharmacy Access Act, the Equitable Community Access to Pharmacist Services Act (ECAPS), a proposed audit of the TRICARE pharmacy program and the Pharmacists Fight Back Act.
Medicaid reform is particularly important. IPC has advocated for policies establishing pharmacy reimbursement based on the National Average Drug Acquisition Cost (NADAC) plus a cost-of-dispensing payment, helping create a reimbursement model more closely tied to what pharmacies actually pay to acquire and dispense medications.
With control of Congress changing hands, the lame-duck period action is uncertain to provide any additional opportunity for the current Congress to advance bipartisan pharmacy measures before priorities, committee leadership and legislative strategies reset in January.
A New Congress, but PBM Reform Is Not Finished
Earlier this year, Congress enacted significant PBM reforms through the Consolidated Appropriations Act of 2026. Those reforms include new transparency requirements and important Medicare Part D changes involving PBM compensation, pharmacy network participation, contract terms and pharmacy access.
But passing legislation was only the beginning.
Many of the major provisions will not take effect until the 2028 and 2029 plan years, making implementation and congressional oversight critical.
That means an incoming Democratic Congress will inherit an important responsibility: ensuring CMS implements the reforms as Congress intended while determining whether additional action is needed around PBM market concentration, vertical integration, Medicaid reimbursement and pharmacist services.
Divided Government Changes the Path, Not Necessarily the Opportunity
Democratic congressional control paired with a Republican administration creates a divided government. That can make major partisan legislation more difficult, particularly when presidential approval is required.
But pharmacy policy does not fit neatly into partisan lines.
PBM reform has attracted support from lawmakers in both parties, as demonstrated by the bipartisan reforms enacted earlier this year. Bipartisan PBM Reforms Signed into Law That creates an opportunity for independent pharmacy advocates to continue building coalitions around issues where lawmakers can find common ground: fair reimbursement, PBM accountability, patient choice, rural healthcare access and expanding pharmacists’ ability to provide reimbursable healthcare services.
For IPC members and affiliates, the takeaway is simple: the election changes the political landscape, but it does not change our priorities. IPC will continue working with policymakers from both parties to protect independent pharmacy, strengthen patient access and make sure the voice of community pharmacy is heard as a new Congress begins its work.
