Drug Middlemen Got Paid More When Your Medicine Cost More. Medicare's New Rule Starts Cutting That Cord
On Oct. 20, CMS proposed rules to limit Part D pharmacy benefit managers to flat, fair-market service fees, give about 6 million of the poorest seniors $0 generics from 2028, and grade Medicare Advantage directories. In our view, it is reform conservatives can love.
By Clara Hughes
ALTAS WORLD NEWS OPINION | By Clara Hughes, Chief Opinion Editor | October 20, 2026 | 6-min read The three largest pharmacy benefit managers process about 80 percent of America's prescription drug claims, according to Federal Trade Commission reports that Medicare cites [1]. They decide which drugs your plan covers and on what tier, and for years much of their pay has been tied to the price of the very drugs they manage. On Tuesday, Medicare published the rule that starts to cut that cord in Part D [1]. In our view, seniors should cheer it, and Washington should finish the job on time. Key Takeaways CMS proposed on Oct. 20 to implement three sections of the Consolidated Appropriations Act, 2026, enacted Feb. 3, 2026: pharmacy benefit manager (PBM) accountability, Medicare Advantage provider directory accuracy, and a $0 generic copay for the poorest dual-eligible seniors [1]. Under the law, PBM pay in Part D must generally be limited to "bona fide service fees": flat dollar amounts, at fair market value, not contingent on a drug's price or rebates [1]. The generic copay for full-benefit dual eligibles at or below the poverty line would drop to $0 starting with 2028 plans; CMS estimates about 6 million enrollees would be affected