CMS Finalizes Changes to Bona Fide Service Fee Requirements, Alongside Other Adjustments to Medicare Part B Drug Reimbursement Methodology (Employee Benefit Plan Review)

In their recent Employee Benefit Plan Review article, Goodwin partners Heath R. Ingram, Matt Wetzel, Greg Demske, Ilene Albala, Roger A. Cohen, and Kirk Ogrosky explain that the Centers for Medicare & Medicaid Services (CMS) has released its final rule for the 2026 calendar year’s physician fee schedule, detailing significant updates to Medicare Part B payment policies. These changes will directly affect drug manufacturers’ government price reporting obligations and the calculation of average sales price (ASP). The final rule took effect on January 1, 2026. Drug manufacturers should prepare for more stringent requirements regarding the classification of bona fide service fees, expanded documentation obligations, and a heightened risk that certain fees may be reclassified as price concessions. The changes may negatively impact ASP and trigger downstream effects in the Medicaid Drug Rebate Program, which often benchmarks reimbursement methodology against ASP.

Read the full analysis: “CMS Finalizes Changes to Bona Fide Service Fee Requirements, Alongside Other Adjustments to Medicare Part B Drug Reimbursement Methodology” (Employee Benefit Plan Review)