The Centers for Medicare & Medicaid Services proposed a rule on Friday to implement healthcare provisions from the February government funding package, focusing on Medicare Advantage provider directory accuracy and pharmacy benefit manager payment reform. The rule would require MA plans to check and update their provider directories at least once every 90 days, and would protect seniors from higher out-of-network costs if they relied on an inaccurate directory.
The proposal builds on a final rule from last fall that required MA plans to update directories within 30 days of learning about changes and attest to accuracy annually. Under the new rule, plans would also need to report an accuracy score to CMS and publicly post it on their directories. The verification and cost-sharing protections would take effect in 2028, with public accuracy scores required by 2029. CMS said the data collected could feed into a future national provider directory.
For PBMs, the rule would restrict compensation in Medicare Part D to flat service fees that cannot be based on drug price, rebates, or formulary placement. PBMs would have to pass through rebates to plan sponsors and report annual information on compensation, spending, and formulary decisions. The rule also implements a provision lowering generic drug copays to $0 for low-income seniors dually eligible for Medicare and Medicaid. CMS said it expects to release another proposed rule with MA and Part D policy changes later this fall.