One Big Beautiful Bill: What it Means for Independent Pharmacy and How to Prepare for the Impact

H.R.1, also known as The One Big Beautiful Bill Act (OBBA), is a big deal. It’s packed with sweeping changes that touch nearly every corner of federal policy. But for independent pharmacies, the most immediate and personal impact is clear: it’s about your patients.

H.R.1 introduces major cuts to Medicaid and the Affordable Care Act (ACA), which could shrink your patient base and disrupt the continuity of care. Millions of Americans—many of whom rely on independent pharmacies—are at risk of losing coverage or facing new barriers to access. And while the bill does include some wins for pharmacy operations (like the long-overdue end of spread pricing), the overall landscape is shifting fast.

Our mission at RedSail is to empower pharmacies to thrive—not just survive—in times of change. That means helping you understand what’s coming, how it affects your business, and what you can do to stay ahead.

The H.R.1 Impact on Independent Pharmacy’s Patients

H.R.1. is a core component of President Trump’s second term agenda and was signed into law on July 4, 2025. The bill contains many tax and spending provisions, addressing policies across student debt, SNAP (federal food assistance), student loans, and of course, healthcare.

For pharmacists, the legislation presents several risks and potential disruptions to service, primarily surrounding changes to patients covered by Medicaid.

The most critical impact? The bill enacts an estimated $1 trillion in reductions to the Medicaid program, with the Congressional Budget Office (CBO) estimating 10.6 million losing Medicaid enrollment by 2034.

So, how are the cuts impacting patients? Here are a few ways H.R.1 is cutting the Medicaid base:

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For independent pharmacies, this means an already thinning patient population.

Melanie Christie, Senior Vice President of Product at RedSail Technologies noted, “Independent pharmacies play a vital role in their local communities, providing necessary care to those who may not otherwise receive it. This bill reduces Medicaid coverage, which in turn threatens pharmacies by shrinking their patient base.”

That’s because this bill specifically hurts the most vulnerable. In 2023, a National Institute of Health study estimated 15.1 million Americans who rely on independent pharmacies are more likely to live in rural areas, have lower incomes, and be older than 65 years of age.

Unfortunately, Medicaid isn’t the only federal program getting cut.

In addition, OBBA does not renew Affordable Care Act (ACA) tax credits, which lowered premiums for millions of enrollees. As a result, CBO estimates at the end of 2026, 4.2 million people will lose coverage due to $700/year average premium increases. On top of the tax credits, H.B.1. increases administrative headaches for consumers like shortening the enrollment period, eliminating automatic enrollment, and more.

While this bill potentially impacts the size of a community pharmacy’s patient population, independent pharmacies also garner some major wins.

Wins for Independent Pharmacy

Spread Pricing in Medicaid Gets the Axe

Spread pricing, aka the classic PBM power move, is no longer. For all Medicaid and its managed care programs, PBMs can no longer charge Medicaid for more than it reimburses the pharmacy (and keep the profits).

Now, the government is requiring PBMs reimburse pharmacies based on the National Average Drug Acquisition Cost (NADAC) plus the state’s Medicaid fee-for-service dispending fee, making reimbursements fairer and more equitable for pharmacies.

Alongside this change, pharmacies will be mandated to report drug acquisition costs through a NADAC survey to help determine the benchmark pricing.

“This marks a significant improvement for our customers, many of whom were previously missing out on revenue due to spread pricing. These changes will help pharmacies more accurately forecast income and manage cash flow,” said Christie.

How to Prepare for the Changes

With some aspects of H.B.1. going into effect as early as October 2026, it's crucial community pharmacies begin preparing.

Christie shared several strategies to help manage the changes from the bill:

• Know Your Patient Population. “Run a financial impact assessment of your current patient mix to understand what percentage of your revenue is from Medicaid and the ACA marketplace. It’s crucial to understand how you might be affected to put together a strategic plan,” noted Christie.

• Educate Your Customers. “Independent pharmacies are uniquely positioned to manage this change,” said Christie. “Continue developing strong relationships with your patients, ensuring they understand the upcoming changes, how they might be affected, and what action steps they should take, if any.”

• Expand Clinical Services. “If you haven’t done it already, now is the time. Providing additional resources to your patients is crucial in today’s environment. With your patient population potentially decreasing, ensure these services are billable, things like: chronic-care management, medication therapy management, and more.
• Utilize Your Resources. “Not only does CMS provide a range of helpful resources—make sure you’re leaning on professional industry organizations like the National Community Pharmacist Association (NCPA), American Pharmacist Association (APhA), and others that provide in-depth analysis of policy updates and changes for independent pharmacies,” highlights Christie.

For questions on additional change management strategies and how RedSail can support you and your pharmacy through this process, please reach out to marketing@redsailtechnologies.com.