The policies ultimately adopted by CMS could influence reimbursement, network access, contracting practices, audits and other aspects of the pharmacy-plan relationship. 

On September 24, 2026, the Centers for Medicare and Medicaid Services (CMS) took a significant step toward implementing new Medicare Part D pharmacy contracting requirements enacted by Congress earlier this year by issuing a request for information (RFI) seeking input on how the agency should develop standards governing the “reasonable and relevant” terms and conditions under which pharmacies participate in Part D networks. The RFI, which was published earlier than anticipated by industry stakeholders, has a comment deadline of November 23, 2026.

For pharmacies, the RFI provides an important opportunity to weigh in on issues that could materially affect their relationships with Part D plans and their ability to participate in Medicare drug plans. The policies ultimately adopted by CMS could influence reimbursement, network access, contracting practices, audits and other aspects of the pharmacy-plan relationship. Pharmacies therefore should consider the RFI not simply as a regulatory development, but as an opportunity to provide CMS with concrete examples of contracting practices and marketplace conditions that affect their businesses and their ability to serve Medicare patients.

CMS is seeking stakeholder feedback on a broad range of important pharmacy contracting practices, including:

• Reimbursement and dispensing fees, including the methodology and standards used to compensate pharmacies;
• Network participation, including the terms under which pharmacies may enter and remain in Part D networks;
• Specialty pharmacy definition, including the adoption of a uniform definition of “specialty pharmacy” for purposes of Medicare Part D contracting;
• Specialty pharmacy networks, including limited or exclusive networks;
• Contract transparency and the disclosure of material contract terms;
• Quality and performance requirements imposed on participating pharmacies;
• Audits and audit-related practices; and
• Other contractual provisions and practices affecting pharmacies participating in Part D networks.

Pharmacies should closely examine the RFI and assess how the issues identified by CMS intersect with their own Part D contracting experiences. Those issues related to concerns involving reimbursement, network restrictions, specialty pharmacy designations, contract terms, audits and other practices that affect their ability to participate in Part D networks.

In light of the November 23, 2026, deadline, it is imperative that pharmacies act quickly to provide comments to CMS on these issues critical to independent pharmacies.

About Duane Morris

The Duane Morris Pharmacy Litigation Group represents pharmacies regarding these critical issues and will be providing guidance to clients on participating in this RFI process.

For More Information

If you have any questions about this Alert, please contact Jonathan L. Swichar, Bradley A. Wasser, an attorney in our Pharmacy Litigation Group or the attorney in the firm with whom you are regularly in contact.

Disclaimer: This Alert has been prepared and published for informational purposes only and is not offered, nor should be construed, as legal advice. For more information, please see the firm's full disclaimer.