AMCP Nexus 2026 preview: PBM reform rollout and drug pricing policy top the agenda

Health plan, PBM and pharmacy industry leaders are gathering in San Diego this week for AMCP Nexus 2026, where the rollout of federal pharmacy benefit manager (PBM) reform, drug pricing policy and artificial intelligence (AI) are expected to shape much of the conversation. The meeting opened today with pre-conference programs, and most education sessions will run Tuesday and Wednesday before it wraps up Thursday.

Leaders from the Academy of Managed Care Pharmacy (AMCP) spoke with Managed Healthcare Executive about what attendees can expect and what health plan and PBM leaders should watch heading into 2027.

PBM reform shifts from Congress to implementation

Adam Colborn, vice president of government affairs at AMCP, said the Consolidated Appropriations Act of 2026 (CAA), signed into law earlier this year, is having the largest effect on managed care pharmacy. The law included long-debated PBM reforms such as required rebate pass-through.

Colborn cited an IPD Analytics analysis showing that rebate retention made up about 55% to 60% of PBM revenue in 2019 but only about 10% in 2025.

“I think it does have some operational changes,” he said. “I also think the sort of big impacts that people were maybe hoping for had already happened incrementally in market-driven negotiations.”

Reporting is a bigger operational issue, according to Colborn. For example, plans and PBMs face new CAA transparency requirements along with a pending Department of Labor rule on reporting for ERISA plans. He said many comments urged regulators to align the two.

“When you have different reporting requirements on the same thing, it can sometimes muddy the waters,” he said. “I think just aligning those is good, but depending on what the final rule looks like, that could have some impacts as well.”

He also flagged CMS’ newly finalized GLOBE model, a most favored nation (MFN) pricing effort for certain Medicare Part B drugs. CMS scaled it back sharply, now estimating that four manufacturers will face mandatory participation, down from about 40 in the proposal, according to an analysis from Goodwin. Colborn’s first reaction was that the rule was “kind of a nothing burger,” but payer and PBM colleagues told him that even a handful of drugs means building a new reimbursement process.

Medicare negotiation and what to watch in 2027

AMCP is not pushing for specific changes to Medicare drug price negotiation, as Colborn said it is “the law of the land” and is unlikely to be modified.

He pointed instead to cash flow strain from the Medicare Transaction Facilitator (MTF), which routes manufacturer refunds to pharmacies for drugs with negotiated prices. Delays this year eased by the end of February, but Colborn expects them to return each January as new drugs enter the program, with independent pharmacies hit hardest.

“Pharmacies are struggling a little bit with the MTF, especially independent pharmacies where you don’t have as much of a buffer for disruptions to your cash flow,” he said, adding that there could be more to be done.

On further PBM legislation, Colborn said Congress has moved on for the most part.

“I think the big push has died down a little bit,” he said. “I think Congress feels like it got its bite at the apple on this one, and now they want to focus on something else like 340B or launch prices for drugs.”

However, ideas such as minimum pharmacy dispensing fees, “gold carding” exemptions from prior authorization, a mandatory National Average Drug Acquisition Cost survey and a ban on Medicaid spread pricing could resurface.

Looking to the near future, Colborn said he sees little appetite for a large healthcare package after the election.

“I think depending on how the election goes, it could be a very chaotic lame duck, and so when that’s the situation, anything can happen,” he added. “But I would say the prevailing mood is sort of pessimism about a big end-of-year healthcare package.”

What AMCP wants health plan and pharmacy leaders to take home

Susan Cantrell, CEO of AMCP, told MHE the meeting comes at a difficult moment for the field.

“These are really challenging and uncertain times for any of us in healthcare, but especially in the managed care pharmacy space,” Cantrell said. “Just the myriad drug pricing policies and all the federal and state legislation that’s coming at us. Not to even mention this increasing interest and influence of AI and how it might change our practice.”

She said she wants attendees to leave with practical solutions to those challenges and a sense of how they may affect their organizations now and in the future. She added that interest appears strong.

Attendance at this year’s meeting is expected to be between 2,500 and 3,000 guests, which could make this the largest Nexus since the pandemic, Cantrell said.

Looking to 2027, AMCP will keep carrying out its strategic plan, which centers on access, affordability and outcomes; community and organizational excellence. Its practice leadership work will focus on real-world evidence, AI, precision medicine, metabolic health and bringing the patient voice into healthcare decision-making, she added.

AI takes center stage at Nexus

Cantrell said AMCP members see AI as a way to improve productivity and, ideally, patient access and affordability, as long as guardrails are in place.

The opening keynote comes from Eric Topol, M.D., founder and director of Scripps Research Translational Institute, and a cardiologist who wrote about AI in medicine in his 2019 book Deep Medicine. Cantrell said comparing his predictions with where the field stands today should be useful for attendees. The meeting will also feature an on-stage debate weighing AI’s risks against its promise for productivity and decision quality.

“AI, for example, can potentially be useful in prior authorization and other utilization management strategies, but you have to make sure that you have that human oversight and intervention,” she said.