CMS proposes rule to curb Medicare Advantage 'ghost networks' and PBM fees
CMS proposed a rule on October 16, 2026 requiring Medicare Advantage plans to verify and update provider directory listings at least every 90 days, publicly report directory accuracy scores, and cap enrollee cost-sharing at in-network rates when a directory wrongly lists a provider as in-network. The same proposal would limit pharmacy benefit managers handling Part D drugs to flat, itemized service fees that cannot depend on drug prices or rebates, starting with contract year 2028. CMS Administrator Mehmet Oz said the changes are meant to give enrollees more reliable directory information and stronger financial protections. The agency is accepting public comments for 60 days after the rule publishes in the Federal Register.
Why it's notable: Inaccurate 'ghost network' directories and rebate-driven PBM compensation are long-running sources of billing disputes and network confusion for practices and patients; a finalized rule would change what MA plans must disclose and how PBMs get paid starting in 2028.