CMS Proposes Reforms to Strengthen Transparency and Affordability in Medicare Advantage and Part D
The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would improve the accuracy of provider directories for Medicare Advantage plans, establish transparency and compensation requirements for Pharmacy Benefit Managers (PBMs), and deliver enhanced cost-saving protections for low-income Medicare beneficiaries.
“CMS has been working to improve data connectivity and accuracy in provider directories across the healthcare system,” said CMS Administrator Mehmet Oz. “The actions we are proposing today will give Medicare Advantage and Part D enrollees more reliable information, stronger financial protections, and greater confidence in both programs.”
To ensure beneficiaries have reliable and up-to-date information, CMS is proposing to make improvements to Medicare Advantage provider directories. This proposal establishes a clear framework to significantly improve the accuracy of provider directories for Medicare Advantage plans. Under the proposed rule, plans would be required to verify and update their provider directory information at least every 90 days and report an accuracy score to CMS. These scores would also be prominently displayed on the plans’ public-facing directories, empowering beneficiaries to choose plans with confidence.
This proposal protects beneficiaries from unexpected costs and care disruptions that can occur when they rely on inaccurate directory information to find an in-network provider. By codifying these standards, CMS is strengthening enrollee protections and increasing transparency across the Medicare Advantage program. In addition, CMS is proposing that enrollees who rely on inaccurate directory listings that led them to receive care by an out-of-network provider would pay no more than their in-network cost-sharing amount. These changes are part of a broader effort to modernize provider directories and ensure beneficiaries can easily find and access the care they need.
CMS is also proposing transparency and reporting requirements for PBMs aimed at curbing practices that drive up drug costs. PBMs would have to report their compensation and cost performance to plan sponsors and CMS on an annual basis. The rule would also require PBM payments to reflect fair market value for services provided, rather than drug costs.
The proposed changes for Contract Year (CY) 2028 for Medicare Advantage and Part D to implement these key sections of the CAA will be open for public comment for 60 days following publication in the Federal Register here: https://www.federalregister.gov/public-inspection/current. CMS anticipates releasing another proposed rule consisting of policy and technical changes for Parts C and D later this fall.
For more information, please view the fact sheet at: https://www.cms.gov/newsroom/fact-sheets/medicare-program-implementation-sections-6219-6220-6224-consolidated-appropriations-act-2026-cms.
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