Medicare Proposes Prescription Savings and New Pharmacy Oversight Rules
Published Date: 10/20/2026
Proposed Rule
Summary
This new Medicare rule will help people with low incomes pay less for their prescriptions, make sure health provider lists are accurate, and hold pharmacy benefit managers more accountable. If you use Medicare Part D or work with pharmacies and providers, these changes could affect you starting soon. Comments on the rule are open until December 15, 2026, so now’s the time to speak up!
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
Zero Generic Copay for Lowest-Income Duals
If you are a full-benefit dual eligible (Medicare and Medicaid) with income at or below 100% of the Federal Poverty Level, the generic drug copayment for Medicare Part D would be $0 for plan years beginning on or after January 1, 2028. CMS estimates about 6 million enrollees would be affected; currently the generic copayment for plan year 2026 is $1.60 and will be $0 under this rule for the specified population.
Stronger Provider Directory Rules for MA
Medicare Advantage plans that are 'specified MA plans' must keep accurate online provider directories starting contract year 2028. Plans must verify provider information at least every 90 days (or every 12 months for certain hospitals and large facilities), remove a provider within 5 business days if they are no longer in-network, include specific data elements (for example: name, specialty, contact, addresses, whether accepting new patients, disability accommodations, cultural/linguistic capabilities, telehealth capabilities, and common ownership/control), and publicly report accuracy scores (with machine-readable display required for contract year 2029).
Pharmacy Benefit Manager Accountability Rules
CMS proposes new Medicare Part D rules for pharmacy benefit managers (PBMs) and affiliates that would limit or specify allowed remuneration for services, require PBMs to report data to Part D plan sponsors and CMS, require transparency for price guarantee arrangements, require PBMs to disclose terms of certain agreements with drug manufacturers, define key terms, and establish compliance and enforcement tools including disgorgement of funds to CMS for violations.
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Key Dates
Department and Agencies
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