CMS Seeks Public Comment on Key Information Collections for Drug Pricing, Basic Health Programs, and Medicare Part D Contracts
On September 1, 2026, the Centers for Medicare & Medicaid Services (CMS) published a notice in the Federal Register, initiating a 60-day public comment period on three distinct information collection activities. This action, mandated by the Paperwork Reduction Act of 1995 (PRA), offers stakeholders a crucial opportunity to influence how CMS gathers data for critical federal healthcare programs. The initiatives span retail drug pricing, state-level health programs, and the administration of Medicare's prescription drug benefit, reflecting CMS's ongoing efforts to ensure program integrity and responsiveness to evolving healthcare landscapes.
Retail Drug Pricing and Medicaid Reimbursement
The first item is an extension of a currently approved information collection titled "Survey of Retail Prices" (CMS-10241, OMB control number 0938-1041). This monthly survey is fundamental to how states determine reimbursement for Medicaid covered outpatient drugs. CMS may contract with a vendor to collect data on the average acquisition costs of these drugs from retail community pharmacies across the nation. The collected prices represent a nationwide average of consumer purchase prices, accounting for discounts and rebates.
The primary output of this collection is the National Average Drug Acquisition Cost (NADAC). NADAC serves as a vital pricing benchmark for states, assisting them in developing fair and accurate reimbursement methodologies. By regularly surveying drug acquisition costs directly from pharmacies, CMS ensures the NADAC reference file remains current, reflecting market realities and helping to manage drug expenditures within the Medicaid program. This collection primarily affects the private sector, specifically businesses and other for-profit entities, with an estimated 72,000 respondents contributing to 36,000 annual hours of burden.
Basic Health Program Revisions
The second information collection, a revision to the "Basic Health Program (BHP) Supporting Regulations" (CMS-10510, OMB control number 0938-1218), addresses a key component of the Affordable Care Act (ACA). Section 1331 of the ACA provides states with the option to establish a BHP, which offers affordable health benefits coverage to low-income residents who would otherwise qualify for coverage through the Health Insurance Exchange.
BHPs are designed to enhance continuity of care for individuals whose incomes fluctuate above and below Medicaid and Children's Health Insurance Program (CHIP) eligibility thresholds. This particular revision proposes significant changes stemming from sections 71301 and 71302 of the Working Families Tax Cut legislation. It aims to remove state eligibility for BHP funding attributable to certain non-citizens. Notably, while state funding eligibility for these individuals would change, the proposal maintains BHP program eligibility for the same non-citizens, suggesting a potential shift in financial responsibility or funding mechanisms for their coverage. The affected public for this collection includes state, local, and tribal governments, with an annual burden of 7,744 hours across 4 respondents.
Medicare Part D Plan Contracts
The third notice concerns a revision of the "Solicitation for Applications for Medicare Prescription Drug Plan 2028 Contracts" (CMS-10137, OMB control number 0938-0936). This annual information collection is crucial for the operation of the Medicare prescription drug benefit, known as Part D. Coverage for Part D is delivered through various entities, including contracted Prescription Drug Plans (PDPs), Medicare Advantage plans that integrate prescription drug and healthcare coverage (MA-PD plans), Cost Plans regulated under Section 1876 of the Social Security Act, and Employer Group Waiver Plans (EGWPs).
Organizations seeking to provide Part D services must complete an application, negotiate rates with CMS, and receive final approval. Existing Part D sponsors wishing to expand their service areas also utilize this application process. The collection of this information is mandated by Part D of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), with application requirements codified in Subpart K of 42 CFR 423. CMS uses the collected information to ensure that applicants meet the necessary requirements for offering Part D plans, including network adequacy, contracting compliance, and overall program integrity. This data is also vital in determining contract awards. The affected public includes individuals and households, as well as the private sector, encompassing both non-profit institutions and for-profit businesses. The estimated annual burden for this collection is 1,643.47 hours across 750 respondents.
Opportunity for Public Feedback
The overarching purpose of this Federal Register notice is to invite public comment on these three critical data collection instruments. Under the PRA, CMS is required to publish such notices to allow 60 days for public input on proposed actions, including extensions or reinstatements of existing collections. Interested parties are encouraged to provide feedback on the estimated burden, the necessity and utility of the proposed information collection, ways to improve data quality and clarity, and the potential use of automated collection techniques to minimize administrative burdens. Comments are due by November 2, 2026, and can be submitted electronically via regulations.gov or through postal mail.
