Policy Shifts Ahead: Expert Reviews Key Legislative Trends Reshaping Health-System Pharmacy

At the 2025 Pharmacy Futures meeting hosted by the American Society of Health-System Pharmacists (ASHP), pressing legislative and regulatory issues took center stage during a conversation with Tom Kraus, MHS, Vice President of Government Relations. As policy developments unfold rapidly at both the state and federal levels, Kraus highlighted the expanding scope of pharmacist practice through a wave of state-level legislation as a key opportunity. However, he also pointed to serious challenges on the horizon—especially around drug pricing, 340B reimbursement cuts, and potential site-neutral payment policies that could significantly impact hospital and health-system funding.

Q: What are some of the most pressing political or legislative issues currently affecting health-system pharmacy practice at the state or federal levels?

Tom Kraus, MHS: Obviously, there's a lot of change going on in in government right now. I think the most exciting opportunities that I see right now are the changes that are happening at the state level. So, we've already seen this year alone 20 different bills that have passed in states to expand pharmacist scope of practice. That's obviously super exciting. Several of those are starting to kind of incorporate standard of care models, which is also another area I think we're going to start to see a lot more of. That'll be exciting

At the federal level, there's obviously a lot of changes going on that have implications for health system practice. For example, there are the changes in drug pricing. So, the president had an executive order on drug pricing, and one of the things that that incorporated was a signal to the agencies to look at acquisition costs for 340B-covered entities. Now, it didn't come out and directly say, “Reduce reimbursement for covered entities,” but I think what's important for folks to understand is that acquisition cost survey is the first required step for Medicare to be able to reduce reimbursement to Medicare to 340B-covered entities. So, I think it's important that folks understand that we are likely to see reimbursement cuts coming for 340B entities in the future.

I guess the other thing I would just mention as a risk, a political risk right now, relates to site-neutral payment. So, your readers might be familiar that there's obviously this big legislative package that's moving through Congress right now,and one of the challenges with getting that bill passed is that it's very expensive, so Congress is looking for dollars to pay for that bill. Well, one of the things that they could turn to [in order to] capture savings for the government is to implement a site-neutral payment policy, which would reduce reimbursement to hospitals for procedures and imaging, but also for drug administration. And if they do that, you know, that would generate savings for the government, but it would reduce significantly reimbursement to health systems, and that'sconcerning.