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.
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