CMS Issues Transformative Final Rule for Medicare Programs Effective 2026

In a significant regulatory development, the Centers for Medicare & Medicaid Services (CMS) announced a comprehensive final rule on April 4, 2025, aimed at refining and advancing the Medicare Advantage (MA), Medicare Prescription Drug Benefit (Part D), and other related programs.

Scheduled to take effect in the Contract Year (CY) 2026, the rule introduces substantive modifications to prescription drug coverage, including enhancements to the Medicare Prescription Payment Plan and the Medicare Drug Price Negotiation Program.

Additionally, it focuses on improving dual eligible special needs plans (D-SNPs) and updating the criteria for Star Ratings, ensuring a more efficient and cost-effective service delivery. The rule also formalizes previously informal guidelines within the MA and Part D frameworks, securing more stable regulatory grounds for future operations.