Federal Register #CMS-4217-NC

Request for Information: Medicare Part D Pharmacy Contracting Standards

CMS, part of the Department of Health and Human Services, is seeking input to develop standards for pharmacy contract terms under Medicare Part D. - Government Buyer: - Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services - Scope of RFI: - Solicits information and recommendations for establishing standards for reasonable and relevant pharmacy contract terms and conditions - Focuses on pharmacy reimbursement, dispensing fees, quality measures, auditing, and implementation - Covers all types of pharmacies: retail, mail order, home infusion, long-term care, specialty, compounding, and Indian Health Service pharmacies - Addresses network arrangements, geographic location, drug types, plan types, and vertical integration in the prescription drug supply chain - No specific OEMs or vendors are named; the RFI is policy-focused, not product procurement - Notable Requirements: - Standards must ensure any pharmacy meeting contract terms can participate in Part D networks - Input will inform rulemaking for compliance starting with plan years beginning on or after January 1, 2029

Description

This request for information (RFI) solicits input from interested parties to establish standards for reasonable and relevant pharmacy contract terms and conditions under the Medicare prescription drug benefit. It is mandated by Section 6223(a) of the Consolidated Appropriations Act, 2026, which requires Part D plan sponsors to allow any pharmacy meeting standard contract terms to participate as a network pharmacy. The standards must be established by the Secretary of the Department of Health and Human Services by April 2028 for plan years beginning January 1, 2029. The RFI seeks detailed input on various topics including pharmacy reimbursement, dispensing fees, and contract provisions to inform future rulemaking.

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