2026 Medicare Advantage – Part D Final Rule Summary

On April 4, 2025, the CMS placed on public display at the Federal Register a final rule revising regulations affecting Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plans, and Programs of All-Inclusive Care for the Elderly. The rule implements changes related to prescription drug coverage, the Medicare Prescription Payment Plan, dual eligible special needs plans, Star Ratings, and other programmatic areas, including the Medicare Drug Price Negotiation Program. This rule also codifies existing subregulatory guidance in the Part C and Part D programs. The regulations are effective June 3, 2025, with applicability dates of January 1, 2026, unless noted otherwise. The final rule omits a substantial number of provisions that were included in the proposed rule. In the appendix to this summary, there is a table showing the sections that were not addressed in this final rule, their section numbers in the proposed rule, and the page number of the summary of the proposed rule where the policy provision was described. In the Fact Sheet for this rule, CMS said it may address these proposals in future rulemaking; however, for three particular provisions, the agency explicitly stated it is not finalizing them:

• Enhancing Health Equity Analyses: Annual Health Equity Analysis of Utilization Management Policies and Procedures,
• Ensuring Equitable Access to Medicare Advantage Services—Guardrails for Artificial Intelligence, and
• Part D Coverage of Anti-Obesity Medications and Application to the Medicaid Program.