CMS发布拟议规则实施2026年综合拨款法第6219/6220/6224条：Part D低收入仿制药共付$1降为$0、MA医疗服务者名录准确性要求及PBM问责，2028计划年生效

Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026 (CMS-4214-P)
Background
On Oct. 16, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to implement key sections of the Consolidated Appropriations Act of 2026 including section 6220 (Requiring Enhanced and Accurate Lists of (REAL) Health Providers Act) and section 6224 (Modernizing and Ensuring Pharmacy Benefit Manager Accountability). This rule also proposes a conforming change mandated by section 6219 of the CAA (Adjustments to Medicare Part D Cost-Sharing Reductions for Low-Income Individuals) that would reduce the generic drug copayment from $1 to $0 for full-benefit dual eligible individuals.
Implementing Certain Provisions of Consolidated Appropriations Act, 2026
On February 3, 2026, the CAA of 2026, which included several changes to the MA and Part D programs, was signed into law. In this rule, we are proposing to implement the following sections:
- Adjustments to Medicare Part D Cost-Sharing Reductions for Low-Income Individuals (Section 6219): This proposed rule implements Section 6219 of the CAA that would reduce the generic drug copayment from $1 to $0 for full-benefit dual eligible individuals at or below 100% of the Federal Poverty Level, effective for plan years starting Jan. 1, 2028.
- Requiring Enhanced and Accurate Lists of (REAL) Health Providers Act (Section 6220): CMS proposes to codify regulations to implement the REAL Health Providers Act, which establishes new provider directory verification and accuracy requirements for MA organizations beginning in contract year 2028. Specifically, CMS proposes requirements to implement this new law related to provider directory verification and maintenance standards, annual accuracy analysis and reporting, public reporting of accuracy scores, and cost-sharing protections for enrollees who rely on inaccurate provider directory information. CMS also proposes to codify the statutory requirements for contract year 2029, including that CMS must publicly display provider directory accuracy scores in a machine-readable format, and MA organizations must prominently display those scores in their provider directories. Through these proposed codifications implementing the REAL Health Providers Act, CMS seeks to promote provider directory accuracy and accountability among MA organizations to ensure that beneficiaries are provided with clear, accurate information on the network of providers available to meet their healthcare needs.
- Modernizing and Ensuring Pharmacy Benefit Manager Accountability (Section 6224): CMS has several proposals to implement section 6224 of the CAA, which established requirements related to pharmacy benefit managers (PBMs) and their affiliates specific to the Medicare Part D program. These proposals include new requirements governing the remuneration that PBMs and their affiliates may receive for services in connection with the utilization of Part D drugs, data reporting by PBMs to Part D prescription drug plan (PDP) sponsors and CMS, transparency in PBM price guarantee arrangements, disclosure by PBMs to PDP sponsors of the terms of certain agreements between PBMs or their affiliates and pharmaceutical manufacturers, and other requirements added by the CAA. CMS also proposes to define key terms related to such requirements and establish compliance and enforcement mechanisms, including disgorgement of funds to CMS for violations of the remuneration requirements.
The proposed rule will be open for public comment for 60 days following publication in the Federal Register.
View this regulation on the Federal Register. The proposed rule will be open for public comment for 60 days following publication in the Federal Register.
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