CMS Releases the CY2026 Advance Rate Notice and Draft Part D Program Instructions

February 11, 2025

EGWP Medicare

On Jan. 10, CMS released the Calendar Year (CY) 2026 Medicare Advantage and Part D Advance Notice which includes methodological and payment policy changes for the programs in 2026. The Advance Notice also includes draft program instructions for CY 2026 for the Medicare Part D program under the redesigned Part D benefit as required by the IRA.

CMS is proposing growth rate and policy changes that it expects will collectively result in an average +2.23% change in Medicare Advantage (MA) plan revenue in 2026 compared to 2025, excluding the impact of risk score trend. Actual revenue impact will vary across plans. CMS is also proposing to complete its three-year phase-in of the updated MA risk adjustment model, which represents a rate headwind for MA plans. As part of the 2026 Part D IRA Program Instructions, CMS explains that it will determine the level of premium stabilization and the risk corridors for participating standalone prescription drug plans (PDPs) under the PDP Premium Stabilization Demonstration following submission of bids for CY 2026. Cigna worked with the business to evaluate the Advance Notice and submitted comments by the Feb. 10 deadline. CMS will publish the Final Rate Announcement and Part D Program Instructions no later than April 7.

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HHS Releases 2026 Notice of Benefit and Payment Parameters Final Rule

On Jan. 13, HHS issued the final Notice of Benefit and Payment Parameters for 2026 (NBPP). HHS states the rule finalizes safeguards to protect consumers from unauthorized changes to their coverage, measures to ensure the integrity of federally run marketplaces, and provisions to make it easier for consumers to understand costs and enroll in coverage. […]
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February 11, 2025

EGWP marketplace medicaid Medicare

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HHS Proposes Changes to HIPAA Security Rule

On Dec. 27, HHS issued a proposed rule to modify the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule to require health plans, health care clearinghouses, most health care providers, and their business associates, to strengthen cybersecurity protections for individuals’ electronic protected health information (ePHI).  The proposals would address: changes in the […]
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February 11, 2025

EGWP marketplace medicaid Medicare

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HHS Withdraws Proposed Rule Expanding Coverage of OTC Preventive Products; SCOTUS Agrees to Hear ACA Case

On Jan. 13, HHS withdrew a proposed rule intended to expand coverage of recommended preventive services without cost-sharing in commercial employer and individual plans, with a particular focus on reducing barriers to coverage of contraceptive services by prohibiting prescription requirements for over-the-counter contraceptives. Last month, the Departments also withdrew a proposed rule intended to expand […]
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February 11, 2025

EGWP marketplace medicaid Medicare

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Biden Administration Issues Rules for Prescribing Controlled Substances via Telemedicine

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February 11, 2025

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Alaska Department Issues Bulletin on HB 226 Implementation and PBM Registration

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