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A proposed rule would cut the Part D generic copay from $1 to $0 for the lowest-income dual eligibles in 2028, tighten Medicare Advantage directory accuracy, and add PBM transparency rules. Comments close 15 December.
The final FY2027 rule lifts the federal per diem base rate to $912.40 and the electroconvulsive-therapy rate to $688.59 from 1 October, adds a standardised patient-assessment tool, and drops two quality measures.
A mandatory CMS payment model finalised 2 October recalculates inflation rebates for certain physician-administered drugs against an international benchmark, and can cut a patient's coinsurance to 10%.
CMS took comment through 18 September 2026 on draft rules for how manufacturers must deliver negotiated drug prices in 2028. The mechanism is a refund owed within 14 days, not a lower shelf price.
The RAPID pathway would issue a proposed national coverage decision the day a device clears the FDA, cutting a process that normally runs 9 to 12 months. The trade-off is evidence.
A 2025 rule created billing codes for FDA-cleared mental-health software. The 2026 rule adds short-episode remote-monitoring codes but declines to widen the digital-therapy benefit.
A $7.9 billion program now pays practices an additional 12.5% on top of the standard Medicare rebate for every bulk-billed visit — split evenly between the clinic and the doctor who sees the patient.
Tirzepatide has been approved for obstructive sleep apnea since December 2024. A January 2026 reanalysis of the trial behind that approval separates what weight loss fixed from what treating the breathing fixed.
The pandemic-era rules letting Medicare patients see a doctor from home, anywhere in the country, are now locked in through the end of 2027 — the longest extension since they were created.
The public comment window just closed on a proposal that would govern how up to 20 high-cost drugs a year get their Medicare prices negotiated, starting with prices that take effect in 2029.
Physician surveys report delays and abandoned treatment; those are self-reported. A harder number: a federal audit found 13% of Medicare Advantage denials met Medicare's own coverage rules.
For many older generics, discount cards and cost-plus pharmacies undercut insured prices. One analysis found Medicare could have saved $3.6 billion on 77 generics buying at cash-plus prices.
Medicare's cap is statutory; the commercial version is a voluntary manufacturer promise with conditions. Before the caps, 1.3 million adults rationed insulin because of cost.
The prices apply only to 10 drugs, only in Medicare, and only from January 2026. Here is exactly which drugs, by how much, and who actually sees the difference.
The final rule raises operating payment rates 2.4% and directs about $2.9 billion more to acute-care hospitals in the year from 1 October 2026. Hospital groups called the increase too low.
Across all drugs, US prices are 2.78 times those in 33 other wealthy countries. The gap is not that Americans use more medicine — it is that no one sets the launch price.
A study of 1.8 million Medicare beneficiaries found vaginal estrogen prescriptions went unfilled by the overwhelming majority — and were least likely of all in women with recurrent urinary tract infections.
The WISeR model starts on 1 January in six states. The contractors running it are paid out of the savings their determinations produce — the design feature doctors keep pointing at.
For the first time, Part D limits annual out-of-pocket drug spending to $2,000, with an option to pay it in monthly installments. Over a million heart patients alone were spending more.