Opportunity
Federal Register #CMS-4214-P
CMS proposes Medicare Advantage and Part D regulatory changes
Buyer
Centers for Medicare & Medicaid Services (CMS), U.S. Department of Health and Human Services
Posted
October 20, 2026
Respond By
December 15, 2026
Identifier
CMS-4214-P
CMS proposes changes to Medicare Advantage and Part D regulations to implement provisions of the Consolidated Appropriations Act, 2026. - Government buyer: Centers for Medicare & Medicaid Services (CMS), within the U.S. Department of Health and Human Services (HHS). - Proposal scope: Updates to Medicare Part C (Medicare Advantage) and Part D (prescription drug benefits); this is a proposed rule, not a procurement or contract award. - Beneficiary cost-sharing: Eliminate generic-drug copayments for qualifying full-benefit dual eligible individuals with incomes at or below 100% of the Federal Poverty Level. - Provider directories: Establish requirements for verification and maintenance, accuracy analysis and reporting, public accuracy scores, and cost-sharing protections when enrollees rely on inaccurate directory information. - Pharmacy benefit managers (PBMs): Establish requirements addressing remuneration, data reporting to Part D plan sponsors and CMS, transparency in price-guarantee arrangements, disclosure of certain pharmaceutical manufacturer agreements, and compliance and enforcement. - OEMs, vendors, products, and quantities: None identified; no products or services are being purchased. The notice requests public comments.
Description
This proposed rule would implement sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026, through amendments to Medicare Advantage (Part C) and Medicare Prescription Drug Benefit (Part D) regulations. It proposes reducing generic-drug copayments to $0 for certain low-income full-benefit dual eligible individuals starting in 2028, and establishing provider-directory accuracy, verification, reporting, and enrollee cost-sharing protections for Medicare Advantage organizations. It also proposes new requirements for pharmacy benefit managers and their affiliates concerning remuneration, data reporting, price-guarantee transparency, disclosures, and compliance and enforcement. Comments are due by 5 p.m. Eastern Standard Time on December 15, 2026.