The Centers for Medicare and Medicaid Services (CMS) recently released a Medicare Advantage (MA) and Part D proposed rule implementing three specific Medicare program provisions required as part of the Consolidated Appropriations Act (CAA), 2026 codified earlier this year. CMS notes that the broader annual MA and Part D policy and technical changes proposed rule will be released later this fall. The three provisions include:
- A $0 generic drug copayment for full-benefit dual eligible individuals at or below 100% of the Federal Poverty Level
- New MA provider directory verification and accuracy requirements. Specifically, MA plans must meet provider directory verification and maintenance standards, conduct and report annual accuracy analyses, public display CMS-reported accuracy scores, and limit enrollee cost-sharing to in-network amounts when the enrollee relied on inaccurate provider directory information.
- Pharmacy Benefit Manager (PBM) transparency and oversight requirements, including reporting all price concessions and fees, disclosing pharmacy payment terms, and complying with strengthened CMS standards intended to prevent anti-competitive practices and improve beneficiary access.
AHCA/NCAL will be submitting comments, which are due on December 15. The provisions would take effect beginning contract year 2028.