Congress Must Act Now
to Save Senior Access to Meds

Congress Must Act Now
to Save Senior Access to Meds

LTC Pharmacies Need a Sustainable Payment Model Before It's Too Late!

LTC Pharmacies Need a Sustainable Payment Model Before It’s Too Late!

Save Senior Rx Care

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The Issue

Lowering prescription drug prices shouldn't inadvertently limit senior access to the essential services provided by LTC pharmacies.

  • Lower drug prices are good for consumers, but the policy changes driving them have unintended consequences for LTC pharmacies, facilities, and patients, threatening access to medicines and essential pharmacy services, increasing costs, and encouraging more anticompetitive consolidation in health care.
  • The impact on LTC pharmacies will be severe and unless Congress acts, many small LTC pharmacies—which represent more than 90% of the sector—will close their doors in 2026.  

The Issue

Lowering prescription drug prices shouldn't inadvertently limit senior access to the essential services provided by LTC pharmacies.

Lower drug prices are good for consumers, but the policy changes driving them have unintended consequences for LTC pharmacies, facilities, and patients, threatening access to medicines and essential pharmacy services, increasing costs, and encouraging more anticompetitive consolidation in health care.

The impact on LTC pharmacies will be severe and unless Congress acts, many small LTC pharmacies—which represent more than 90% of the sector—will close their doors in 2026.  

The Problem

Recent Medicare drug pricing policy changes and an outdated pharmacy payment model threaten the future of LTC pharmacies.

  • The LTC pharmacy payment model is flawed. Medicare Part D Plans administered by pharmacy benefit managers (PBMs) force LTC pharmacies to subsidize inadequate payment for their specialized services with revenues from expensive brand name drugs. Policies driving lower drug prices like the American Rescue Plan and Inflation Reduction Act will unintentionally break the model with catastrophic consequences.
  • LTC residents rely heavily on insulin, inhalers, and 8 of the first 10 drugs subject to negotiated Medicare prices in 2026. If the flawed payment model isn’t fixed, most LTC pharmacies may not survive, and many seniors will lose access to essential services. The problem will only get worse as more branded drugs are subject to price negotiations each year.

The LTC pharmacy payment model is flawed. Medicare Part D Plans administered by pharmacy benefit managers (PBMs) force LTC pharmacies to subsidize inadequate payment for their specialized services with revenues from expensive brand name drugs. Policies driving lower drug prices like the American Rescue Plan and Inflation Reduction Act will unintentionally break the model with catastrophic consequences.

LTC residents rely heavily on insulin, inhalers, and 8 of the first 10 drugs subject to negotiated Medicare prices in 2026. If the flawed payment model isn’t fixed, most LTC pharmacies may not survive, and many seniors will lose access to essential services. The problem will only get worse as more branded drugs are subject to price negotiations each year.

The Solution

Congress must protect senior access to meds and essential services by establishing a sustainable LTC pharmacy Part D payment model before 2026.

  • Congress must ensure that Medicare Part D payments for LTC pharmacy services reflect the actual cost of essential and legally required services and must account for cost increases over time.
  • Congress must give CMS the direction and authority to level the negotiating playing field for pharmacies by assuring that Part D contracts allow LTC pharmacies to maintain services.

The Solution

Congress must protect senior access to meds and essentials services by establishing a sustainable LTC pharmacy Part D payment model before 2026.

Congress must ensure that Medicare Part D payments for LTC pharmacy services reflect the actual cost of essential and legally required services and must account for cost increases over time.

Congress must give CMS the direction and authority to level the negotiating playing field for pharmacies by assuring that Part D contracts allow LTC pharmacies to maintain services.

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LTC PHARMACIES PLAY A UNIQUE ROLE
IN CARING FOR SENIORS

LTC PHARMACIES PLAY A UNIQUE ROLE
IN CARING FOR SENIORS

LTC pharmacies provide specialized services to patients in long-term care as required by federal law. There is no substitute for the essential services they provide, including: enhanced medication management, consultant services, patient-specific packaging, heightened quality controls, 24/7/365 delivery and more.

LTC PHARMACIES BY THE NUMBERS

LTC PHARMACIES BY THE NUMBERS

2000000

# of Rx Meds LTC pharmacies dispense to Part D patients

1200

# of LTC pharmacies serving 2M residents in LTC settings nationwide

13

avg. # of Rx medications prescribed to patients in LTC settings

75 %

of LTC Pharmacy revenues from Part D

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