CMS has proposed a rule requiring Medicare Advantage plans to verify provider directories every 90 days and cap PBM compensation — protecting the 36 million seniors enrolled in MA from surprise costs and opaque drug pricing practices. Accuracy scores will be publicly displayed, and seniors misled by inaccurate directories won't pay more than in-network rates. Most changes kick in by 2028.
CMS has proposed a sweeping rule to tackle two long-standing headaches in Medicare Advantage: inaccurate provider directories (often called "ghost networks") and murky pharmacy benefit manager (PBM) compensation. The rule, which implements provisions from the Consolidated Appropriations Act of 2026 signed by President Trump in February, would require MA plans to audit and update their provider directories at least once every 90 days — a significant step up from the current annual attestation standard.
Seniors who receive care from an out-of-network provider due to a directory error would be protected from paying more than their in-network cost-sharing amount. Plans would also be required to publicly display an accuracy score in their directories, with CMS publishing the data in a machine-readable format so beneficiaries can factor it in when choosing a plan. On the PBM front, the rule limits compensation to flat service fees — no more tying pay to drug prices, rebates, or formulary placement — and mandates annual transparency reporting to plan sponsors and CMS.
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Why it matters: Ghost networks and PBM opacity have long frustrated patients and policymakers alike. These reforms could meaningfully improve care access and cost predictability for tens of millions of Medicare beneficiaries — while forcing greater accountability across the MA and Part D ecosystems.
