Medicare wants to hear from pharmacies, drug plans and patients by Nov. 23 on how Part D plans set the rates they pay pharmacies, the first formal step toward contracting standards the Centers for Medicare & Medicaid Services intends to finish by 2029. The request for information, published Sept. 24 in the Federal Register, does not change how any plan pays any pharmacy today. It opens a 60-day comment period on what “reasonable and relevant” pharmacy contract terms should look like once new standards take hold.
What the comment period doesn’t change: CMS’s request for input on Part D pharmacy payments leaves current drug costs and the out-of-pocket cap unchanged, the costs The Medicare Cost & Coverage Protection Kit is built to track. Track current Part D costs while standards are drafted →
A Request for Comment, Not Yet a Rule
CMS’s filing, approved by CMS Administrator Dr. Mehmet Oz, is a request for information, a step regulators use to gather input before drafting an actual rule, not a proposed or final regulation. The agency lists eight specific areas it wants input on, including pharmacy reimbursement and fees, how contracts define a “similarly situated” pharmacy, quality and performance measures, and how insurers audit and recoup payments from pharmacies. Nothing in the filing changes what a pharmacy is paid, or what a beneficiary owes at the counter, while the comment period runs. CMS has not proposed specific dollar figures or a specific reimbursement formula in the request itself; the document poses questions for commenters to answer rather than laying out draft rules for them to react to, which is typical of a request for information at this early a stage.
The Law Behind the Request
CMS ties the request to Section 6223(a) of the Consolidated Appropriations Act, 2026, a provision that amended Section 1860D-4(b)(1)(A) of the Social Security Act to direct the agency to define fair contracting standards between Part D plans and the pharmacies that fill their members’ prescriptions. The statute set CMS on a multi-year clock: the agency must finalize the standards by April 2028, so they can apply to Part D plan years that begin Jan. 1, 2029.
Why the Runway Runs to 2029
A three-year gap between a request for comments and a rule taking effect is not unusual for contracting standards this broad. Part D plans and pharmacy benefit managers negotiate network contracts years in advance, and CMS has said the standards need to be finalized well before the 2029 plan year so insurers can build them into contracts they are already negotiating. A rule announced with too little lead time risks arriving after plans have already locked in the very pharmacy terms it is meant to change, which is part of why CMS is starting the comment process now rather than waiting until closer to the 2028 finalization deadline. The comment period closing Nov. 23 is the point at which the public, including pharmacies and patient advocates, can shape what those standards eventually require.
Why Pharmacy Payment Reaches Patients
How much a Part D plan pays a pharmacy is not simply an industry dispute. Independent and rural pharmacies have cited low or delayed reimbursement as a reason for closing or dropping out of insurer networks in recent years, and a pharmacy’s exit from a plan’s network can leave nearby Medicare beneficiaries driving farther, or paying more, to fill the same prescription. The standards CMS is now gathering comments on are meant to address exactly that dynamic, though any effect on where a patient can fill a prescription will not arrive until 2029 at the earliest. In the meantime, a pharmacy dropping out of a plan’s network can force a beneficiary to either pay a higher out-of-network price, transfer a prescription somewhere less convenient, or switch Part D plans entirely at the next enrollment opportunity.
How the Comment Process Actually Works
A request for information is CMS’s way of gathering evidence before it writes an actual regulation, and it typically draws responses from pharmacy trade groups, Part D plans, pharmacy benefit managers and patient advocacy organizations rather than individual beneficiaries in large numbers. Comments submitted by Nov. 23 become part of the public record CMS is required to consider before it drafts a proposed rule, a step that would itself go through its own separate comment period before anything is finalized by the April 2028 deadline Congress set. That layered process is why an RFI issued in September can still be years away from changing anything a beneficiary or a pharmacy actually experiences.
What Still Affects Costs Today
While the pharmacy-contracting standards are years away, the levers that determine what a Medicare beneficiary pays for prescriptions right now have not moved. The Part D out-of-pocket cap, which limits covered drug spending to $2,100 in 2026 and $2,400 in 2027 before catastrophic coverage takes over, still applies exactly as it did before the RFI was published, and beneficiaries with limited income can apply for Extra Help, a program the Social Security Administration also processes applications for, to lower premiums and copays further. Comments on the pharmacy-contracting request can be filed through Nov. 23; a beneficiary’s own drug costs for 2026 and 2027 depend on those existing programs, not on anything the RFI decides.
Managing Drug Costs While the Rules Are Still Being Written
CMS’s request for comment could eventually change how Part D plans pay pharmacies, but any resulting standards will not apply before 2029. The out-of-pocket cap, Extra Help eligibility and current plan costs are the practical questions a Medicare beneficiary still has to sort out in the meantime.
The Medicare Cost & Coverage Protection Kit includes 51 state Medicare cost-help packs and a medication and cost tracker for keeping current drug spending organized.
Look up the cost-help programs available in your state →
This article was produced with AI assistance and checked against the primary sources linked above.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
