Section 6223(a) of the Consolidated Appropriations Act, 2026 requires the Secretary of Health and Human Services to establish these standards. The law mandates that the standards be established no later than the first Monday in April 2028.

The resulting standards will apply to Medicare Part D plan years beginning on or after January 1, 2029. Section 6223(a) also amends section 1860D-4(b)(1)(A) of the Social Security Act to implement these changes.

The legislation requires Part D plan sponsors to permit any pharmacy that meets standard contract terms and conditions to participate as a network pharmacy. Section 6223(a) further required the Secretary to issue a request for information not later than April 1, 2027.

Part D plan sponsors contract with the Centers for Medicare & Medicaid Services to provide the Part D benefit through standalone prescription drug plans or Medicare Advantage plans. These sponsors must establish contracted pharmacy networks that meet convenient access standards specified in 42 CFR 423.120(a).

The file code for comments on the request is CMS-4217-NC. Electronic comments may be submitted via regulations.gov docket CMS-2026-3037.

Written comments may be mailed to P.O. Box 8013, Baltimore, MD 21244-8013. Express or overnight mail comments may be sent to Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. All comments received before the close of the comment period are available for public viewing on regulations.gov. The Centers for Medicare & Medicaid Services will not post public comments that make threats to individuals or institutions.

Beckie Peyton is the contact for general questions related to section 6223 of the Consolidated Appropriations Act, 2026. The phone number for Beckie Peyton is (410) 786-1572. The email address for Beckie Peyton is PartDPolicy@cms.hhs.gov. Stakeholders may use these contact methods to seek clarification on the legislative requirements.

Why It Matters

Medicare Part D was enacted as part of the Medicare Modernization Act of 2003 and went into effect on January 1, 2006. Under Medicare Part D, drug benefits are provided by private insurance plans that receive premiums from both enrollees and the government.

The Centers for Medicare & Medicaid Services is a federal agency within the United States Department of Health and Human Services that administers the Medicare program. The establishment of contract term standards represents a regulatory step affecting how these private plans interact with pharmacy networks.

Timeline

The Health and Human Services Department published notice titled "Agency Information Collection Activities: Proposed Collection; Comment Request" on 2026-09-22.

The Centers for Medicare & Medicaid Services issued a request for information to establish standards for reasonable and relevant pharmacy contract terms under Medicare Part D on 2026-09-23. The Health and Human Services Department published rule titled Patient Protection and Affordable Care Act; Temporary Moratoria on Certain Agent and Broker Registration To Participate in the Exchanges on 2026-09-23.

Section 6223(a) requires the Secretary to issue a request for information not later than April 1, 2027. The standards apply to Medicare Part D plan years beginning on or after January 1, 2029.