CMS Seeks Input on Pharmacy Benefit Manager Rules
Published Date: 6/18/2026
Proposed Rule
Summary
The government wants to learn more about how Pharmacy Benefit Managers (PBMs) get paid and share data, so they can follow new rules starting in 2028. This affects PBMs, drug plans, and anyone using Medicare Part D drugs. They’re asking for your thoughts by July 20, 2026, to help shape fairer payments and better info sharing—potentially saving money and making drug costs clearer!
Analyzed Economic Effects
2 provisions identified: 1 benefits, 0 costs, 1 mixed.
Limits on PBM Pay for Part D Drugs
Starting in calendar year 2028, the law imposes restrictions on the remuneration that pharmacy benefit managers (PBMs) and their affiliates may receive for services connected to the use of covered Medicare Part D drugs. CMS is requesting technical input to inform rulemaking that will define allowable payments, the meaning of a "bona fide service fee," and how to determine "fair market value."
Annual PBM Data Reporting to CMS and Plans
Not later than July 1 of each year, beginning in 2028, PBMs must submit an annual report covering the prior plan year to both the prescription drug plan (PDP) sponsor and the Secretary. The report must include detailed information on drug utilization and dispensing activity, drug costs and pricing, enrollee out-of-pocket spending, direct and indirect remuneration (DIR), pharmacy reimbursement, overall plan spending, and revenue retained by the PBM or its affiliates.
Personalized for You
How does this regulation affect your finances?
Personalize government policy and PRIA will tell you what this federal register document means for your household, plus every other regulation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.
Key Dates
Department and Agencies
Related Federal Register Documents
2026-15686, Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
This final rule updates the hospice wage index, payment rates, and aggregate cap amount for fiscal year 2027. This final rule also includes an analysis of Medicare non-hospice spending, including details regarding a hospice service and spending variation index, and finalizes the requirement that hospices provide the hospice election statement addendum to all Medicare beneficiaries at the time of hospice election. Additionally, this rule finalizes conforming changes to discharge from hospice care regulations and changes to the face-to-face encounter regulations. This final rule also includes a summary of comments received on our requests for information regarding community- based palliative care; the construction of a hospice specific wage index; and the overlap between hospice and medical aid in dying laws. Finally, this rule finalizes changes to the Hospice Quality Reporting Program.
2026-15652, Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2027 and Updates to the IRF Quality Reporting Program
This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2027. As required by statute, this final rule includes the classification and weighting factors for the IRF prospective payment system's (PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2027. It also finalizes the third and final of the 3-year phaseout of the rural adjustment, which began in FY 2025. This final rule includes a solicitation for public comments on alternative data sources for the IRF PPS wage index; requires all therapy treatments and/or therapy evaluations to begin no later than 36 hours from midnight on the day of admission; finalizes requirements for the initial Interdisciplinary Team meeting to occur on or before 4 days from the date the patient is admitted; and summarizes a request for information on potential future IRF PPS payment reform. Additionally, this final rule includes updates to the IRF Quality Reporting Program and changes to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.
2026-15562, Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027
Starting October 1, 2026, skilled nursing facilities (SNFs) will see updated payment rates and new rules for how Medicare pays them. The Quality Reporting and Value-Based Purchasing programs are also getting tweaks to help improve care. These changes affect SNFs nationwide and could impact how much money they get and how they report quality data.
2026-14897, Medicaid Program; Amending the Indirect Hold Harmless Threshold of Health Care-Related Taxes
Starting October 1, 2026, new rules will change how states handle health care-related taxes under Medicaid. These changes set clear limits on tax amounts based on 2025 levels and will gradually lower those limits in some states by 2027. States and taxpayers should get ready for tighter rules and better oversight that could affect tax collections and Medicaid funding.
2026-14709, Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program; Correction
This correction fixes some typos and technical mistakes in the 2027 health insurance rules under the Affordable Care Act. It mainly affects people and organizations involved in health coverage plans by clarifying when the rules take effect and restoring some important regulation details. These fixes take effect on July 20, 2026, ensuring smoother and clearer health plan operations next year.
2026-14327, Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
Starting in 2027, Medicare and Medicaid are updating how doctors and clinics get paid to better match today’s medical care and laws. This includes new rules for drug price rebates, shared savings programs, and payments for rural and specialty care. These changes affect doctors, patients, and drug makers, aiming to save money and improve care quality.
Previous / Next Documents
Previous: 2026-12341, Domestic Dates Produced or Packed in Riverside County, California; Increased Assessment Rate
If you grow or pack dates in Riverside County, California, get ready! The fee you pay per hundredweight of dates is proposed to jump from 5 cents to 25 cents starting with the 2025-2026 crop year. This change helps support the date industry and will stay in place until something new comes along. Don’t forget to share your thoughts by July 20, 2026!
Next: 2026-12362, Airworthiness Directives; Airbus Helicopters
If you own or fly Airbus Helicopters AS355 models, heads up! The FAA found some tail rotor parts might be mislabeled, which could be unsafe. They want you to check serial numbers, inspect parts if needed, and replace or fix any wrong ones—all before August 3, 2026. This keeps your helicopter safe and flying smoothly, with some possible costs for inspections or replacements.