CMS seeks input on Medicare Part D pharmacy contracting standards

The Centers for Medicare & Medicaid Services is soliciting public input on the standards that will govern pharmacy contract terms in the Medicare prescription drug benefit, according to a request for information published in the Federal Register on September 24, 2026. Comments must be received by November 23, 2026. The notice, filed under CMS-4217-NC and docket CMS-2026-3037, responds to a mandate in section 6223(a) of the Consolidated Appropriations Act, 2026.

The statutory mandate

Section 6223(a) of the Consolidated Appropriations Act, 2026, titled “Assuring Pharmacy Access and Choice for Medicare Beneficiaries,” amends section 1860D–4(b)(1)(A) of the Social Security Act. It requires Part D plan sponsors to permit any pharmacy that meets the plan’s standard contract terms and conditions to participate as a network pharmacy.

For plan years beginning on or after January 1, 2029, those standard terms must be reasonable and relevant under standards set by the Secretary of the Department of Health and Human Services, to be established no later than the first Monday in April of 2028. The law also directed the Secretary to issue a request for information no later than April 1, 2027; CMS has published it well ahead of that deadline.

Part D plan sponsors — private companies contracting with CMS — must already build networks meeting convenient-access standards at 42 CFR 423.120(a), and must contract with any pharmacy meeting standard terms under § 423.120(a)(8)(i). Reasonableness and relevance are governed by § 423.505(b)(18). CMS noted that in the January 28, 2005 Part D final rule (70 FR 4254) it clarified that payment terms may vary by geography or pharmacy type, provided similarly situated pharmacies receive the same terms, and that it has not set further requirements since.

What CMS wants to know

The RFI is organized into eight topic areas:

• Pharmacy reimbursement and dispensing fees, including maximum allowable cost (MAC) pricing, “lesser of” pricing, aggregate guarantees such as generic and brand effective rates, and post-adjudication adjustments.
• Current contracting practices, including how sponsors define “similarly situated” pharmacies and whether any-willing-pharmacy terms are offered in preferred networks.
• Trends in contract terms, including multi-line agreements covering Medicaid managed care, commercial and exchange business.
• Pharmacy quality and performance measures, including alignment with Part D Star Ratings.
• Auditing practices, including recoupment, extrapolation methods and due process.
• Limitations on dispensing covered Part D drugs by network pharmacies.
• Existing regulations and guidance needing clarification.
• Implementation of the eventual standards, including timelines and compliance documentation.

CMS also asks how the new standards would overlap with pharmacy benefit manager disclosure requirements and remuneration restrictions under section 1860D–12(h) of the Act, and about the role of pharmacy services administrative organizations, 340B terms, “brown bagging” and “white bagging,” and the effect of maximum fair prices negotiated under the Inflation Reduction Act of 2022.

Deadlines and contacts

• Comments are due November 23, 2026, and must reference file code CMS-4217-NC.
• Submissions may be filed electronically at regulations.gov, by regular mail to CMS in Baltimore, or by express mail to 7500 Security Boulevard, Baltimore, MD 21244–1850.
• General questions go to Beckie Peyton at (410) 786–1572 or PartDPolicy@cms.hhs.gov.
• The notice was approved on September 15, 2026 by Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services, and signed by Robert F. Kennedy, Jr., Secretary of the Department of Health and Human Services.

The RFI is issued solely for information and planning purposes and does not commit the government to any procurement or grant. CMS said it will consider all input as it develops future proposals or policy guidance, and may publicly post the comments received.

The outcome will shape how millions of Medicare beneficiaries reach a pharmacy counter. Pharmacies have long complained that reimbursement terms are set in rate sheets and provider manuals outside the executed contract, while plan sponsors and pharmacy benefit managers warn that rigid standards could raise premiums. The standards due in 2028 will determine which pharmacies can join a network, on what terms, and how disputes over payment are resolved.

Source: Federal Register, Vol. 91, No. 184, September 24, 2026, Proposed Rules, p. 60568 (official reference: CMS-4217-NC; docket CMS-2026-3037).