Medicare

A federal district court in Georgia issued a sweeping ruling that could potentially undermine the legal foundation of the Medicare Advantage (MA) Star Ratings program and invite additional challenges to policies established through sub-regulatory guidance. The court found that the Centers for Medicare and Medicaid Services (CMS) improperly relied on measures based on data not collected through the statutorily required measurement systems and failed to meet notice-and-comment requirements for certain measures.

The bipartisan Main Street Pharmacy Access Act (H.R. 3164/S. 2426), which would allow Medicare to reimburse pharmacists for testing and treating certain respiratory illnesses in states that already authorize those services, cleared the House Committee on Ways and Means on May 21, 2026.

The Academy of Managed Care Pharmacy (AMCP) thanks the Centers for Medicare & Medicaid Services (CMS) for the opportunity to provide comments in response to the “Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program” (Proposed Rule), issued on July 16, 2025.

In both of his administrations, President Trump promoted most-favored nation (MFN) pricing as a way to bring down drug costs in the United States. On July 31, 2025, President Trump sent letters to 17 pharmaceutical manufacturers demanding that they implement MFN prices or face the consequences.

Medicare Part D sponsors must have concurrent drug utilization review (DUR) systems, policies, and procedures designed to ensure that a review of the prescribed drug therapy is performed before each prescription is dispensed to an enrollee in a sponsor’s Part D plan, typically at the POS or point of distribution as described in 42 CFR § 423.153(c)(2).

On September 9, AMCP submitted comments praising CMS’s proposal to cover Digital Mental Health Treatment devices (DMHTs) under Medicare Part B. AMCP urges CMS to use its authority to cover all FDA-cleared, prescription only digital health products and develop appropriate coding and payment methodologies to promote adoption of these innovative technologies.

View AMCP letter urging Congress to support 12-month continuous eligibility for adults in Medicaid and the Children’s Health Insurance Program (CHIP) by passing the Stabilize Medicaid and CHIP Coverage Act