CMS Proposes Medicare Advantage Directory and PBM Transparency Rules

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would set new accuracy standards for Medicare Advantage (MA) provider directories, establish transparency and compensation requirements for pharmacy benefit managers (PBMs), and provide enhanced cost-saving protections for low-income Medicare beneficiaries, according to an agency press release.

The proposed changes would apply to contract year 2028 for MA and Part D. CMS Administrator Mehmet Oz said the proposals “will give Medicare Advantage and Part D enrollees more reliable information, stronger financial protections, and greater confidence in both programs.”

Under the proposal, MA plans would be required to verify and update provider directory information at least every 90 days and report an accuracy score to CMS. Those scores would also be prominently displayed on plans’ public-facing directories. CMS also proposed that enrollees who receive care from an out-of-network provider because they relied on an inaccurate directory listing would pay no more than their in-network cost-sharing amount. The agency said the provisions are intended to protect beneficiaries from unexpected costs and care disruptions that can occur when inaccurate directory information is used to find an in-network provider.

For PBMs, the rule would require annual reporting of compensation and cost performance to plan sponsors and CMS. It would also require PBM payments to reflect fair market value for services provided rather than drug costs. CMS said these requirements are aimed at curbing practices that drive up drug costs.

The proposed rule will be open for public comment for 60 days following publication in the Federal Register. The release did not detail the proposed protections for low-income beneficiaries but they are available on a fact sheet posted on the agency’s website. CMS said it anticipates releasing a separate proposed rule with policy and technical changes for Parts C and D later this fall.

Source: Centers for Medicare & Medicaid Services. CMS proposes reforms to strengthen transparency and affordability in Medicare Advantage and Part D. Press release. Centers for Medicare & Medicaid Services; October 16, 2026. Accessed October 19, 2026.