CMS Proposes Medicare Advantage Directory Accuracy Rule: Plans Must Verify Provider Listings Every 90 Days and PBMs Must Disclose Pay
The Centers for Medicare & Medicaid Services (CMS) has 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) in Part D, and deliver enhanced cost-saving protections for low-income Medicare beneficiaries. The proposed changes, for contract year 2028, implement sections 6219, 6220, and 6224 of the Consolidated Appropriations Act of 2026, and will be open for public comment for 60 days following publication in the Federal Register.
On directory accuracy, CMS proposes that plans be required to verify and update their provider directory information at least every 90 days and report an accuracy score to CMS. The scores would be prominently displayed on the plans' public-facing directories, empowering beneficiaries to compare how reliable each plan's listings are when choosing coverage.
On cost protection, CMS proposes that enrollees who rely on inaccurate directory listings that led them to receive care from an out-of-network provider would pay no more than their in-network cost-sharing amount, protecting them from unexpected costs and care disruptions.
On drug costs, CMS proposes reporting requirements under which PBMs would report their compensation and cost performance to plan sponsors and CMS on an annual basis, and a requirement that PBM payments reflect fair market value for services provided rather than drug costs, aimed at curbing practices that drive up drug prices. CMS Administrator Mehmet Oz said the agency has been working to improve data connectivity and accuracy in provider directories across the healthcare system, and that the proposals would give Medicare Advantage and Part D enrollees more reliable information, stronger financial protections, and greater confidence in both programs. CMS anticipates releasing another proposed rule on policy and technical changes for Parts C and D later this fall.
Source: GSM · USA (original Chinese edition)
Photo: 美国联邦医疗保险（Medicare）卡样本（资料图）。美国联邦医疗保险和医疗补助服务中心（CMS），公共领域，经 Wikimedia Commons。 / A sample U.S. Medicare card (file photo). Centers for Medicare & Medicaid Services (CMS), public domain, via Wikimedia Commons.
