Medicare Costs Rise, PBM Law Changes
Medicare Part B premiums and deductibles are set to increase in 2026, tightening budgets for hospitals and patients, reported. At the same time, federal PBM reforms that delink Medicare Part D reimbursement from drug rebates were signed into law — a combination that will reshape pricing and bundling strategies for device‑drug combos, reported.
CMS set the 2026 standard Medicare Part B monthly premium at $202.90 and the annual Part B deductible at $283. cms.gov CMS guidance treats commercially available combination products that contain a drug component as Part D drugs unless CMS determines the product “as a whole” belongs in an excluded category, while Part B explicitly covers drugs furnished “incident to” a physician’s service and drugs used with durable medical equipment. cms.gov Congress folded major PBM changes into the Consolidated Appropriations Act, 2026, which President Donald J. Trump signed on Feb. 3, 2026, and the statute shifts Medicare Part D PBM pay toward flat administrative fees and a 100% rebate pass‑through requirement. mintz.com The law phases in key rules on a 30‑month timetable (making many provisions effective by Aug. 3, 2028), requires PBMs to remit rebates to plan clients no later than 90 days after each quarter, mandates semiannual reporting on gross‑to‑net dynamics, and provides roughly $188–$190 million to CMS for enforcement and oversight. groom.com
