CMS asks how PBMs get paid in Medicare Part D

Medicare Part D drug plans could face a closer federal look at how pharmacy benefit managers, or PBMs, are paid. The Centers for Medicare & Medicaid Services, or CMS, is asking for technical input on PBM compensation and data collection as it works to carry out recent legislation, and the rules it is sorting out begin in calendar year 2028.

Comment deadline: 2026-07-20 5 p.m. Submit comments: https://www.regulations.gov/docket/CMS-2026-2212 Effective date: calendar year 2028

PBMs sit between drug plans and pharmacies, handling claims processing, network contracting, prior authorization and other benefit-management work. CMS says it wants to understand those services and business practices before it writes the limits that will govern those payments. This is a request for information, not the final rule.

Where the money line gets drawn

The agency is focused on two requirements that start in 2028: limits on remuneration for services tied to covered Part D drugs, and data reporting requirements. In plain terms, CMS is trying to separate ordinary service fees from payments tied to drug prices, rebates, formulary placement or other business outcomes, because that line can determine how much room PBMs have to structure deals around the drug benefit.

CMS is also asking what counts as a PBM affiliate, and which related businesses should be pulled into the same framework. Its list includes affiliated provider groups, data vendors, rebate aggregators, long-term care pharmacies, mail-order pharmacies, retail pharmacies, specialty pharmacies and other related operations. It is asking how to judge fair market value for those services, since that benchmark helps show whether a payment looks like a routine fee or something else.

The paper trail CMS wants

On the reporting side, CMS says PBMs would have to submit an annual report by July 1 each year, beginning in 2028, covering the prior plan year. The report would go to both the prescription drug plan, or PDP, sponsor and the secretary, and would include drug utilization and dispensing activity, drug costs and pricing, enrollee out-of-pocket spending, direct and indirect remuneration, or DIR, pharmacy reimbursement, overall plan spending and revenue retained by the PBM or its affiliates.

That reporting load is the agency’s window into how money moves through the prescription drug benefit. For enrollees, the debate is less about paperwork than about whether regulators can see enough to police prices, fees and back-end payments that can ripple into what people pay at the pharmacy counter. Comments are due July 20, 2026.

Agency: Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS) Docket ID: CMS-4218-NC RIN: 0938-AW09 CFR parts: 42 CFR Part 423 Comment deadline: 2026-07-20 5 p.m. Effective date: calendar year 2028 Submit comments: https://www.regulations.gov/docket/CMS-2026-2212 Contact: Claire Schreiber • (410) 786-8939 • PartDPBM@cms.hhs.gov