Health · Healthcare & Policy · 5 hrs ago
CMS proposes provider-directory scores and flat-fee limits for PBMs
CMS proposed new rules for Medicare Advantage plans and pharmacy benefit managers on Oct.
16.
The proposal would put public scores on Medicare Advantage provider directories.
It also seeks limits on fees charged by pharmacy benefit managers, or PBMs.
These measures are part of rules to implement sections of the Consolidated Appropriations Act of 2026.
The proposal would add new oversight for health plans and companies that manage prescription drug benefits.
CMS is seeking comments on the proposed rule.
Comments are due Dec.
15; the proposal is not described as a final rule.
CMS proposed new guardrails for pharmacy benefit managers and Medicare Advantage plans.
The proposed rule was released Oct. 16.
It would implement sections of the Consolidated Appropriations Act of 2026.
The proposal includes public scores for Medicare Advantage provider directories and flat-fee limits for pharmacy benefit managers.
Comments are due Dec. 15.
- Who
- The Centers for Medicare & Medicaid Services (CMS).
- What
- CMS proposed guardrails for pharmacy benefit managers and Medicare Advantage plans, including directory scores and flat-fee limits.
- When
- The proposed rule was released Oct. 16. Comments are due Dec. 15; the year is not stated.
- Where
- Not stated.
- Why
- To implement sections of the Consolidated Appropriations Act of 2026.
This story does not have two clearly opposing sides.
CMS released the proposed rule.
The deadline for comments on the proposed rule.
- Proposed-rule release
- Oct. 16
- Comment deadline
- Dec. 15
- Legislation
- Consolidated Appropriations Act of 2026
- Proposed measures
- Public scores for Medicare Advantage provider directories and flat-fee limits for pharmacy benefit managers