Health
CMS proposes protections against inaccurate Medicare doctor directories
The 2028 proposal would strengthen provider lists and prescription-drug middleman reporting; these are not benefits already in effect.
By NewsCubby Newsroom · Published
People comparing Medicare Advantage plans could receive more reliable information about participating doctors under a federal proposal issued Friday. The Centers for Medicare & Medicaid Services also proposed new reporting requirements for pharmacy benefit managers, the middlemen involved in prescription-drug coverage.
The October 16 proposal would require Medicare Advantage plans to verify and update their provider directories at least every 90 days. Plans would report directory-accuracy scores to CMS and display those scores publicly.
There is also a proposed protection for patients who rely on an incorrect listing. If that error leads them to receive care outside the plan’s network, their share of the cost would be capped at the corresponding in-network amount.
For Part D drug coverage, pharmacy benefit managers would report compensation and cost-performance information annually to plan sponsors and CMS. The proposal would tie their payments to the fair market value of services rather than the cost of drugs.
The measures concern contract year 2028 and remain subject to the rulemaking process. CMS says public comments will be accepted for 60 days after publication in the Federal Register. The announcement does not establish an immediate change to a person’s current coverage or guarantee a reduction in a particular prescription’s price.
For beneficiaries choosing a plan now, the practical distinction is between a proposed future safeguard and the benefits actually offered today. Check the current plan documents and confirm a doctor’s network participation directly rather than assuming Friday’s proposal is already operating.