{"id":34303,"date":"2025-04-15T14:25:19","date_gmt":"2025-04-15T18:25:19","guid":{"rendered":"https:\/\/advisory.avalerehealth.com\/?p=34303"},"modified":"2025-04-21T15:34:48","modified_gmt":"2025-04-21T19:34:48","slug":"recent-part-d-final-policies-leave-open-areas-for-future-access","status":"publish","type":"post","link":"https:\/\/advisory.avalerehealth.com\/insights\/recent-part-d-final-policies-leave-open-areas-for-future-access","title":{"rendered":"Recent Part D Final Policies Leave Open Areas for Future Action"},"content":{"rendered":"<p><span data-contrast=\"auto\">In early April, the Centers for Medicare &amp; Medicaid Services (CMS) released final Medicare Advantage (MA) and Part D payment and policy changes for the 2026 plan year. These changes were issued through three documents: the Contract Year (CY) 2026 Policy and Technical Changes <\/span><a href=\"https:\/\/public-inspection.federalregister.gov\/2025-06008.pdf\"><span data-contrast=\"none\">final rule<\/span><\/a><span data-contrast=\"auto\">, the MA and Part D <\/span><a href=\"https:\/\/www.cms.gov\/files\/document\/2026-announcement.pdf\"><span data-contrast=\"none\">Rate Announcement<\/span><\/a><span data-contrast=\"auto\">, and the <\/span><a href=\"https:\/\/www.cms.gov\/files\/document\/final-cy-2026-part-d-redesign-program-instruction.pdf\"><span data-contrast=\"none\">Final Part D Redesign Program Instructions<\/span><\/a><span data-contrast=\"auto\">. Initially proposed under the Biden administration, some provisions were finalized as proposed or with modifications, while others were left unaddressed.\u00a0<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Provisions that were deferred or implemented in a more limited fashion may signal areas the Trump administration could revisit in future policymaking. Several key areas to watch for Part D include:<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Coverage of Anti-Obesity Medications (AOMs): <\/span><\/b><span data-contrast=\"auto\">In the CY 2026 final rule, CMS did not finalize the proposed coverage of AOMs for treatment of obesity under Medicare Part D or Medicaid. Like other policies that were not finalized in the rules, CMS did not provide additional details on stakeholder feedback or the rationale for this decision. However, given the <\/span><a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/02\/establishing-the-presidents-make-america-healthy-again-commission\/\"><span data-contrast=\"none\">Make America Healthy Again<\/span><\/a><span data-contrast=\"auto\"> initiative, the Trump administration may still focus on obesity prevention and treatment, potentially through a Center for Medicare and Medicaid Innovation demonstration or other regulatory action. Future efforts could target broader obesity prevention and treatment interventions in addition to AOMs.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Standalone Prescription Drug Plan (PDP) Premium Stabilization Demonstration: <\/span><\/b><span data-contrast=\"auto\">In the Rate Announcement, CMS stated that it would evaluate CY 2026 bid submissions to \u201cassess the need for, or effectiveness of, the elements of the [PDP premium stabilization] demonstration.\u201d With 2026 bids due by June 2, plans will have less than six months of experience with the new 2025 benefit design to inform their bids. Plans will face additional uncertainty about the future of the demonstration. As noted in the Rate Announcement, CMS may rely on its ability to negotiate proposed bids with plan sponsors to address any significant changes in premiums. All of these factors are likely to impact plan offerings and premiums for 2026.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Medicare Prescription Payment Plan: <\/span><\/b><span data-contrast=\"auto\">The rule finalized automatic re-enrollment into the Medicare Prescription Payment Plan for 2026 and makes some adjustments to beneficiary notification requirements. However, policies for 2026 remain largely unchanged from 2025. As plans, pharmacies, and beneficiaries gain experience with the program, CMS may continue to explore future policy changes, such as revisiting point-of-sale enrollment.\u00a0<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Successor Regulation for Selected Drugs under the Medicare Negotiation Program: <\/span><\/b><span data-contrast=\"auto\">CMS finalized the more limited proposal allowing immediate formulary substitutions of selected drugs with generics and interchangeable biologics only. CMS declined to adopt policies for biosimilar substitutions or allow for broader substitutions via formulary maintenance changes. However, CMS noted that it may identify other successor regulations in the future.\u00a0<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Pharmacy Protections: <\/span><\/b><span data-contrast=\"auto\">CMS did not address proposed policies to strengthen pharmacy protections related to plan sponsor pharmacy networks or contract negotiations. However, with the Trump administration\u2019s ongoing interest in transparency and other pharmacy benefit manager practices, CMS could address these issues as part of broader actions on these topics.\u00a0<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Future decisions in these policy areas could have wide-reaching effects on Part D plan offerings, benefit designs, patient access, and broader market strategies in the coming years. As such, these open policy areas present significant opportunities for stakeholders to engage with CMS and shape future action.\u00a0<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"none\">To learn how Part D policy changes may impact your organization, <\/span><a href=\"https:\/\/info.avalere.com\/LP=46\"><span data-contrast=\"none\">connect with us<\/span><\/a><span data-contrast=\"none\">.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>In early April, the Centers for Medicare &amp; Medicaid Services (CMS) released final Medicare Advantage (MA) and Part D payment and policy changes for the 2026 plan year. These changes were issued through three documents: the Contract Year (CY) 2026 Policy and Technical Changes final rule, the MA and Part D Rate Announcement, and the&hellip;<\/p>\n","protected":false},"author":28,"featured_media":20264,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[3],"tags":[],"content-categories":[259],"class_list":["post-34303","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-insights","content-categories-policy","entry","has-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Recent Part D Final Policies Leave Open Areas for Future Action | Avalere Health Advisory<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/advisory.avalerehealth.com\/insights\/recent-part-d-final-policies-leave-open-areas-for-future-access\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Recent Part D Final Policies Leave Open Areas for Future Action | Avalere Health Advisory\" \/>\n<meta property=\"og:description\" content=\"In early April, the Centers for Medicare &amp; Medicaid Services (CMS) released final Medicare Advantage (MA) and Part D payment and policy changes for the 2026 plan year. These changes were issued through three documents: the Contract Year (CY) 2026 Policy and Technical Changes final rule, the MA and Part D Rate Announcement, and the&hellip;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/advisory.avalerehealth.com\/insights\/recent-part-d-final-policies-leave-open-areas-for-future-access\" \/>\n<meta property=\"og:site_name\" content=\"Avalere Health Advisory\" \/>\n<meta property=\"article:published_time\" content=\"2025-04-15T18:25:19+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-04-21T19:34:48+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/advisory.avalerehealth.com\/wp-content\/uploads\/2020\/08\/3019-1-Kylie_Stengel_600x400-e1597870657980.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"600\" \/>\n\t<meta property=\"og:image:height\" content=\"400\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Leah Keller\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@avalerehealth\" \/>\n<meta name=\"twitter:site\" content=\"@avalerehealth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Leah Keller\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Recent Part D Final Policies Leave Open Areas for Future Action | Avalere Health Advisory","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/advisory.avalerehealth.com\/insights\/recent-part-d-final-policies-leave-open-areas-for-future-access","og_locale":"en_US","og_type":"article","og_title":"Recent Part D Final Policies Leave Open Areas for Future Action | Avalere Health Advisory","og_description":"In early April, the Centers for Medicare &amp; Medicaid Services (CMS) released final Medicare Advantage (MA) and Part D payment and policy changes for the 2026 plan year. These changes were issued through three documents: the Contract Year (CY) 2026 Policy and Technical Changes final rule, the MA and Part D Rate Announcement, and the&hellip;","og_url":"https:\/\/advisory.avalerehealth.com\/insights\/recent-part-d-final-policies-leave-open-areas-for-future-access","og_site_name":"Avalere Health Advisory","article_published_time":"2025-04-15T18:25:19+00:00","article_modified_time":"2025-04-21T19:34:48+00:00","og_image":[{"width":600,"height":400,"url":"https:\/\/advisory.avalerehealth.com\/wp-content\/uploads\/2020\/08\/3019-1-Kylie_Stengel_600x400-e1597870657980.jpg","type":"image\/jpeg"}],"author":"Leah Keller","twitter_card":"summary_large_image","twitter_creator":"@avalerehealth","twitter_site":"@avalerehealth","twitter_misc":{"Written by":"Leah Keller","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/advisory.avalerehealth.com\/insights\/recent-part-d-final-policies-leave-open-areas-for-future-access#article","isPartOf":{"@id":"https:\/\/advisory.avalerehealth.com\/insights\/recent-part-d-final-policies-leave-open-areas-for-future-access"},"author":{"name":"Leah Keller","@id":"https:\/\/advisory.avalerehealth.com\/#\/schema\/person\/fb195190cdd6a0c7c2cc890515dd95f4"},"headline":"Recent Part D Final Policies Leave Open Areas for Future Action","datePublished":"2025-04-15T18:25:19+00:00","dateModified":"2025-04-21T19:34:48+00:00","mainEntityOfPage":{"@id":"https:\/\/advisory.avalerehealth.com\/insights\/recent-part-d-final-policies-leave-open-areas-for-future-access"},"wordCount":555,"commentCount":0,"publisher":{"@id":"https:\/\/advisory.avalerehealth.com\/#organization"},"image":{"@id":"https:\/\/advisory.avalerehealth.com\/insights\/recent-part-d-final-policies-leave-open-areas-for-future-access#primaryimage"},"thumbnailUrl":"https:\/\/advisory.avalerehealth.com\/wp-content\/uploads\/2020\/08\/3019-1-Kylie_Stengel_600x400-e1597870657980.jpg","articleSection":["Insights &amp; 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Prior to joining Avalere, Leah conducted policy research and analysis on federal healthcare issues such as Medicaid coverage and payment, commercial insurance coverage and access, healthcare reform, and ACA implementation at the Guttmacher Institute, a thinktank focused on advancing reproductive health and rights. Prior, Leah coordinated data collection, analysis, and publications for George Washington University\u2019s Center for Social Well-Being and Development. Leah holds an MPH in maternal and child health from George Washington University and a BA in anthropology from St. Mary\u2019s College of Maryland.","url":"https:\/\/advisory.avalerehealth.com\/author\/lkelleravalere-com"}]}},"_links":{"self":[{"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/posts\/34303","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/users\/28"}],"replies":[{"embeddable":true,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/comments?post=34303"}],"version-history":[{"count":4,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/posts\/34303\/revisions"}],"predecessor-version":[{"id":34330,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/posts\/34303\/revisions\/34330"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/media\/20264"}],"wp:attachment":[{"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/media?parent=34303"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/categories?post=34303"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/tags?post=34303"},{"taxonomy":"content-categories","embeddable":true,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/content-categories?post=34303"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}