Federal Register #2026-06600

CMS Final Rule: Policy and Technical Changes to Medicare Advantage, Part D, and Cost Plan Programs

This final rule from the Centers for Medicare & Medicaid Services (CMS) under the Department of Health and Human Services (HHS) revises regulations for Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), and Medicare cost plan programs. - Government Buyer: - Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS) - Key Program Changes: - Redesign of the Part D benefit as required by the Inflation Reduction Act of 2022 - Implementation of the Manufacturer Discount Program, replacing the Coverage Gap Discount Program - Updates to Star Ratings methodology for Medicare Advantage and Part D plans - New requirements for marketing, communications, and supplemental benefits - Includes transparency in eligibility for Special Supplemental Benefits for the Chronically Ill (SSBCI) - Administration of supplemental benefits through debit cards - Changes to drug coverage, enrollment processes, and special needs plans - Notable Requirements: - Focus on transparency, beneficiary access, and program integrity - Rule is considered economically significant and applies to coverage beginning in contract year 2027 - OEMs and Vendors: - No specific commercial OEMs or products are named; only CMS and HHS are referenced as issuing agencies

Description

This final rule revises regulations for Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), and Medicare cost plan programs to implement changes related to Star Ratings, marketing and communications, drug coverage, enrollment processes, special needs plans, and other programmatic areas. It includes implementation of changes from the Inflation Reduction Act of 2022 affecting Part D benefit design, codification of the Manufacturer Discount Program, updates to Star Ratings methodology, and provisions related to supplemental benefits. The rule is effective June 1, 2026, and applies to coverage beginning January 1, 2027.

View original listing