From extensive regulatory reforms to economic pressures reshaping pharmacy access and pricing, these are some of the most impactful pharmacy stories since the start of 2025.
340B program under pressure
The future of the 340B drug pricing program has become a focal point of national healthcare policy debate in the first half of 2025. On April 15, President Donald Trump issued an executive order titled “Lowering Drug Prices By Once Again Putting Americans First,” which revived cuts to Medicare payments for 340B-eligible outpatient drugs. The move was aimed to lower patient costs and increase financial accountability.
However, reactions across the hospital sector have been mixed. Chip Kahn, CEO of the Federation of American Hospitals, supported the order saying it corrects past legal missteps and will ease financial burdens on patients. Bruce Siegel, MD, who leads America’s Essential Hospitals, on the other hand, warned the changes could destabilize safety-net providers who rely on 340B revenue to serve underserved patients.
This executive order comes amid a U.S. Senate investigation led by Sen. Bill Cassidy, MD, into how covered entities are using 340B funding. The inquiry found that health systems such as Cincinnati-based Bon Secours Mercy Health and Cleveland Clinic took hundreds of millions of dollars in 340B savings but offered little direct patient discounting.
Another large shift to the 340B program includes an HHS proposal that would shift oversight of the program to CMS, signaling tighter federal scrutiny of the program.
States tighten grip on PBMs
Pharmacy benefit managers have been facing regulatory pushback in 2025, with new laws aimed at breaking up vertical integration and increasing pricing transparency.
In April, Arkansas became the first state to ban PBMs from owning pharmacies, citing concerns about anti-competitive behavior and access to medications. Arkansas Gov. Sarah Huckabee Sanders called PBMs “drug middlemen” and also said they are inflating costs and restricting care.
North Carolina has also seen significant legislative efforts concerning PBMs. In late April and early May, both the House and Senate passed separate PBM reform bills. The House includes provisions to ban spread pricing and mandate minimum reimbursements for pharmacies while the Senate bill focuses on increasing transparency and supply chain oversight.
On June 11, Iowa joined more than 30 states that have adopted PBM oversight measures in 2025, with Iowa Gov. Kim Reynolds signing a bill tightening PBM practices and banning cost-sharing schemes that favor larger pharmacy chains. The law comes after the closure of 34 rural pharmacies in Iowa last year.
Tariffs add strain to healthcare costs and supply chain
President Trump’s sweeping tariff policies have shaken the healthcare supply chain. On April 5, a 10% baseline tariff on all U.S. imports was imposed, with additional higher rates targeting dozens of trading partners.
In early April, the U.S. imposed a 70% tariff on Chinese imports amid escalating trade tensions, including a baseline 10% tariff starting April 5 and additional hikes that pushed the total tariff on China to as high as 145% by mid-April.
However, following intense negotiations, a provisional agreement was reached in
June 2025, bringing the tariff down to 55%.
Pharmaceuticals were not included in the first wave of additional tariffs, but they were not exempt either. Initial drug ingredients and medical devices are subject to the base tariff and a Section 232 investigation has been underway that could result in even higher levies on pharmaceutical imports.
As a result, hospitals have been bracing for a cost hit. Renton, Wash.-based Providence Health estimated the tariffs could raise its costs by $10 million to $25 million annually. The American Society of Health-System Pharmacists and AHA have also warned the policies could lead to drug shortages, especially for generic sterile injectibles and urged exemptions from medical devices that would be impacted.
A separate analysis from Ernst & Young projected that a proposed 25% tariff on pharmaceutical imports would raise U.S. drug costs by $51 billion annually, pushing some cancer drug prices up by as much as $10,000 for a six-month supply.
Specialty pharmacies gain momentum
In the first half of 2025, health systems have been betting big on specialty pharmacies, with new hubs aimed at improving medication access and bringing down costs.
Santa Barbra, Calif.-based Cottage Health launched its specialty pharmacy program in May and is planning a broader rollout across its three hospitals. Lurie Children’s Hospital in Chicago is also planning to open a new specialty pharmacy in late 2026 at its new infusion center in Schaumburg, Ill.
At Charlottesville, Va.-based UVA Health, a $17 million central pharmacy facility is set to open in January. The 40,000-square-foot hub will use automation and AI tools to boost capacity and support specialty, retail and home delivery services.
