Public Inspection: CMS: Medicare Program: Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026

Federal Register

Oct 19, 2026

Pre-publication notice of a proposed rule that would implement the following sections of the Consolidated Appropriations Act, 2026: 1) section 6219, "Adjustments to Medicare Part D Cost-Sharing Reductions for Low-Income Individuals;" 2) section 6220, "Requiring Enhanced and Accurate Lists of (REAL) Health Providers Act;" and 3) section 6224, "Modernizing and Ensuring Pharmacy Benefit Manager Accountability." The implementation of Section 6219 would reduce the generic drug copayment from $1 to $0 for full-benefit dual eligible individuals at or below 100% of the Federal Poverty Level, effective for plan years starting January 1, 2028. The implementation of Section 6220, the REAL Health Providers Act, would establish new provider directory accuracy and accountability requirements for Medicare Advantage (MA) organizations beginning in contract year 2028. In addition, CMS has several proposals to implement section 6224, which established requirements related to pharmacy benefit managers (PBMs) and their affiliates specific to the Medicare Part D program. Comments are due by December 15, 2026.

Health workforce · Legislation and regulations · Medicare · Medicare Advantage · Pharmacy and prescription drugs · Reimbursement and payment models