On Apr. 15, 2025, CMS published final policy in federal register, effective Jun. 3, 2025.
Provisions applicable to coverage beginning Jan. 1, 2026, except as otherwise noted.
On Nov. 26, CMS proposed contract year 2026 MA, Part D revisions.
CMS proposed rule to revise Medicare advantage (MA), Medicare Rx drug benefit (Part D), Medicare cost plan programs; programs of all-inclusive care for elderly (PACE).
The agency also issued a fact sheet on proposed 2026 policy and technical changes.
The purpose of the proposed actions is to improve care and access for enrollees.
White House issued a fact sheet on the proposal to expand anti-obesity medications.
Aim is to provide for coverage of anti-obesity medication, and enhanced MA, Part D.
Also hold MA and Part D plans more accountable for delivering high-quality coverage.
CMS would no longer exclude anti-obesity medications from coverage under Part D.
Would require Medicaid programs to cover these medications if used to treat obesity.
Proposal would eliminate unnecessary barriers to care by clarifying prior authorization requirements, and establish safeguards for AI use to protect access to health services.
Bolster consumer protections by expanding CMS oversight of MA advertisements.
Promote access to behavioral health care; administration of MA supplemental benefits.
Bolster consumer protections by expanding CMS oversight of MA advertisements.
Includes measures to ensure MA, Part D for seniors and persons with disabilities.
Additionally, CMS proposed to improve consumer tools on the site Medicare.gov.
Consultation
Comments on proposed rule must be submitted no later than Jan. 27, 2025.
Dec. 2024 Fed Reg Proposal
On Dec. 10, 2024, CMS published proposal in federal register, comment Jan. 27, 2025.
Apr. 4, 2025 CMS 2026 Policy
On Apr. 4, 2025, CMS published contract year 2026 policy and technical changes rule.
Amends Medicare advantage, Part D, Medicare Cost Plan Program, and PACE programs
Changes to prescription drug coverage, Medicare Prescription Payment Plan, dual eligible special needs plans, Star Ratings, Medicare Drug Price Negotiation Program.
Codifies Inflation Reduction Act (IRA) vaccine and insulin cost-sharing requirements.
Also codifies program instruction for Medicare Prescription Payment Plan program.
Finalizes two IRA-related provisions to ensure selected drugs with maximum fair prices under the Negotiation Program are available to beneficiaries at the point of dispensing.
