The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on 16 October 2026 that would require Medicare Advantage plans to verify their provider directories at least every 90 days and publish accuracy scores, restrict how pharmacy benefit managers (PBMs) are paid in Medicare Part D, and remove generic drug copays for some of the lowest-income Medicare beneficiaries. CMS said the proposal implements sections of the Consolidated Appropriations Act of 2026, the appropriations law signed in February 2026, and that it will be open for public comment for 60 days following publication in the Federal Register.
Provider Directories: 90-Day Checks and Public Scores
Inaccurate plan directories, sometimes called ghost networks, can send patients to clinicians who are not in network or not accepting the plan. Under the proposal, Medicare Advantage organisations would have to verify and update directory information at least once every 90 days, and check hospital and facility information at least once a year. Beginning in contract year 2028, plans would estimate an accuracy score, described in reporting on the rule as a letter grade, from a sample of listed providers. CMS would publicly post the scores in 2029, in machine-readable form and on plan directories, so beneficiaries could weigh directory reliability when choosing a plan. A companion protection would cap what an enrollee pays when a directory error misleads them: a patient who books a provider listed as in network would pay no more than the in-network cost-sharing amount even if that provider turns out to be out of network, from contract year 2028.
PBM Pay: Flat Fees, Pass-Through Rebates and Annual Reporting
For Part D, the proposal would untie PBM compensation from drug prices. From 1 January 2028, PBMs and their affiliates could accept only flat-dollar, itemised service fees, which could not vary with a drug's price or rebates. Fair market value would be the cost of the itemised service plus a reasonable markup. Manufacturer rebates and discounts would still be permitted, but only where passed through in full to the plan sponsor. PBMs would also report compensation and cost performance to sponsors and CMS each year, return any remuneration the statute does not allow, and allow sponsors to audit them at least once a year on request. CMS Administrator Dr Mehmet Oz said the actions proposed would give enrollees "more reliable information, stronger financial protections and greater confidence in both programs."
$0 Generics for Some Dual Eligibles, and What Happens Next
The rule would also codify a cost change for people enrolled in both Medicare and Medicaid. Full-benefit dual-eligible enrollees at or below 100% of the federal poverty level would pay $0 for generic drugs from plan year 2028, replacing a copay currently set at $1 and indexed to inflation, which put it at $1.60 in 2026. The Medicare programme would absorb the change. CMS expects the directory requirements to raise administrative and compliance costs for Medicare Advantage organisations, and says it does not yet have enough data on PBM contracts to estimate the financial effect of the PBM changes. A further proposed rule with policy and technical changes for Parts C and D is expected later this autumn, and trade coverage reported comments on this rule are due by 15 December 2026.
What This Means for Practices and Plans
For clinics and medical groups, the directory provisions are the part of this proposal most likely to arrive at the front desk. If plans must re-verify listings every 90 days, practices should expect more frequent requests to confirm addresses, phone numbers, clinicians and whether they are accepting new patients. Wrong answers will carry a visible cost, because a plan's public accuracy score will partly reflect how clean its provider data is. Practices can prepare now by auditing their listings in every Medicare Advantage directory they appear in, fixing the same details on their own website and patient portal, and assigning one owner for directory responses. Accurate public listings are also a patient-access issue in their own right, which is why our healthcare directory at https://medclinicx.com/directory is built around verified practice details. Practices that work with Part D plans should also watch the final rule for how flat PBM fees affect formularies and pharmacy workflows from 2028.
Analysis: Directory Accuracy Becomes a Competitive Signal
Analysis (MedClinicX): This is a proposal, not a final rule, and the comment period could change its details before anything takes effect in 2028. What is already significant is the direction of travel. Directory accuracy has usually been treated as a back-office data chore. Publishing a graded score turns it into a competitive signal that plans will have to manage, and one that depends heavily on the data practices supply. Organisations that keep clinician, location and contact data consistent across their own systems, their website and every plan directory will be easier to verify and safer for patients to book. If your practice is reviewing how patients find and book you, our patient portal work at https://medclinicx.com/solutions/ai-patient-portal is one place to start. Nothing in this article is legal advice. Medicare Advantage participants should take compliance advice on the final rule when it is published.
Sources and References
- Centers for Medicare & Medicaid Services (CMS), CMS Proposes Reforms to Strengthen Transparency and Affordability in Medicare Advantage and Part D, 16 October 2026: https://www.cms.gov/newsroom/press-releases/cms-proposes-reforms-strengthen-transparency-affordability-medicare-advantage-part-d
- Becker's Hospital Review, CMS proposes public scores for Medicare Advantage provider directories, flat-fee limits for PBMs, 16 October 2026: https://www.beckershospitalreview.com/legal-regulatory-issues/cms-proposes-public-scores-for-medicare-advantage-provider-directories-flat-fee-limits-for-pbms/
- Fierce Healthcare, CMS proposes MA 'ghost network,' PBM transparency requirements, 16 October 2026: https://www.fiercehealthcare.com/regulatory/cms-proposes-ma-ghost-network-pbm-transparency-requirements
Reporting based on the sources above, accessed 17 October 2026. The CMS fact sheet linked from the agency's press release could not be fetched directly during reporting. Every figure in this article is stated in the CMS press release or in both independent reports above. MedClinicX did not conduct original reporting or interviews for this article. Corrections: contact us via https://medclinicx.com/contact