CMS Targets PBM Fees and MA Directory Accuracy in New Rule

CMS is moving to tighten oversight of two parts of the Medicare machinery that have long frustrated patients and employers: pharmacy benefit managers and Medicare Advantage provider directories. A proposed rule released Oct. 16, reported by Becker's Hospital Review, would implement sections of the Consolidated Appropriations Act of 2026 and is open for public comment through Dec. 15.

Under the proposal, CMS would publish accuracy scores for Medicare Advantage plan provider directories, giving beneficiaries a way to judge whether listed doctors are actually in-network and accepting patients. Inaccurate directories, sometimes called ghost networks, routinely leave enrollees with surprise bills or no accessible care. The rule would also require flat-fee payment arrangements for PBMs, a structural change aimed at breaking the link between drug prices and the middlemen that negotiate them.

For health plans, pharmacy intermediaries, and the vendors that manage directory data, the rule signals rising compliance pressure and more public accountability. Stakeholders have until mid-December to weigh in before CMS finalizes the terms.