Medicare Advantage Plans Face New 2028 Compliance Rules
New CMS requirements for provider directories and PBM transparency will soon mandate significant reporting changes for plan operators.
Updated on Oct. 16, 2026 in Healthcare
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CMS has issued a proposed rule to implement the Consolidated Appropriations Act of 2026, introducing stricter provider directory accuracy standards and new transparency mandates for pharmacy benefit managers. These changes impact Medicare Advantage and Part D plans, with major requirements taking effect in the 2028 and 2029 contract years.
Why it matters
The rule enforces federal transparency requirements that will shift compliance obligations for Medicare Advantage plans and PBMs. Operators must prepare for new data reporting and directory verification workflows to meet federal accountability standards.
The proposed rule cuts generic drug copayments to $0 for qualifying dual-eligible individuals, down from $1. CMS is currently seeking public feedback during a 60-day window following the formal publication of the proposal.
The players
Centers for Medicare & Medicaid Services
A federal agency within the U.S. Department of Health and Human Services that administers Medicare and oversees health insurance regulations.
The details
The rule mandates that Medicare Advantage organizations verify provider directory accuracy and implement new PBM data reporting. CMS will enforce these standards by requiring public display of accuracy scores in machine-readable formats and creating mechanisms for the disgorgement of funds if PBMs violate remuneration requirements.
Timeline
February 3, 2026: Consolidated Appropriations Act of 2026 signed into law.
October 16, 2026: CMS issued the proposed rule.
January 1, 2028: Generic drug copayment reductions take effect.
Contract year 2028: Provider directory verification requirements begin.
Contract year 2029: CMS begins public display of provider directory accuracy scores.
Market Landscape
This regulatory shift follows the mandates set forth in the Consolidated Appropriations Act of 2026. It marks a broader industry trend toward increased transparency and federal oversight of PBM remuneration and provider network management.
Medicare Advantage operators must prepare for a 2028 compliance deadline regarding provider directory verification and updated PBM reporting. Stakeholders should review the proposed rule to assess how the transparency mandates will alter their current administrative and reporting costs.
The takeaway
The rule enforces stricter transparency and directory management that will necessitate significant operational adjustments for plan administrators. Review the forthcoming Federal Register publication to identify specific data reporting thresholds that will take effect in 2028.
What happens next
CMS will accept public comments on the proposed rule for 60 days following its publication in the Federal Register.
Further reading
For broader trends in industry compliance, review the Healthcare section.
More information
To review the full text of the proposal, view this regulation on federal register.
Source note: This article includes information reported by Cms.
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