Drug prices & Part D
CMS Proposes PBM Transparency Rules and Provider Directory Accuracy Standards for Medicare in 2028
A proposed rule published October 16 would require pharmacy benefit managers in Part D to disclose earnings and manufacturer deals to Medicare, require Medicare Advantage plans to publicly score their own provider directories, and cut generic drug copays to zero for the lowest-income dual-eligible enrollees.
By the Goodsurance editorial teamOctober 17, 2026
On October 16, 2026, CMS issued a proposed rule that would implement three provisions from the Consolidated Appropriations Act of 2026, all of which would take effect beginning with contract year 2028.
The largest portion of the rule targets pharmacy benefit managers operating in Medicare Part D. Under the proposal, PBMs and their affiliates would be required to report their compensation and cost performance annually to both plan sponsors and CMS. Payments made to PBMs would need to reflect fair market value for services provided, rather than the cost of the drugs themselves. PBMs would also be required to disclose to plan sponsors the specific terms of any agreements they hold with pharmaceutical manufacturers.
New Medicare proposals would require drug-plan managers to disclose their earnings, require plans to publicly grade their doctor directories, and drop generic drug copays to zero for the lowest-income dual-eligible enrollees.
A second set of provisions, drawn from the REAL Health Providers Act, targets Medicare Advantage provider directories. Plans would be required to verify and update directory information at least every 90 days, calculate an accuracy score, and make that score available for public viewing through CMS. Beneficiaries who relied on a directory listing later found to be inaccurate would owe no more than in-network cost-sharing for the care they received.
A third provision would eliminate the generic drug copayment for full-benefit dual-eligible individuals whose incomes fall at or below 100 percent of the Federal Poverty Level. That copayment currently stands at 1 dollar per prescription. The reduction would take effect January 1, 2028.
The public comment window runs 60 days from Federal Register publication. CMS Administrator Mehmet Oz said the proposals are intended to give Medicare Advantage and Part D enrollees more reliable information and stronger financial protections.
In plain words
Medicare published new proposed rules on October 16 that would start in 2028.
The rules would require companies that manage drug benefits, called PBMs, to tell Medicare how much money they earn and what deals they have with drug makers. Right now that information is often not shared with Medicare.
Medicare Advantage plans would also have to check their doctor directories every 90 days and post a grade showing how accurate those lists are. If a directory said a doctor was covered and the doctor was actually not, the patient would only pay the in-network price.
People who have both Medicare and Medicaid with very low incomes currently pay 1 dollar per generic prescription. Under the new rules they would pay nothing.
The public can send written comments on these proposals for 60 days after they appear in the Federal Register.
Understand the basics first
Source: CMS
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