Pass the LTC Pharmacy Fix Before It’s Too Late!
The new policies driving lower drug prices will have unintended consequences for LTC pharmacies, facilities, and patients. They will threaten access to medicines and essential services, increase costs, and encourage anticompetitive consolidation in health care.
Unless Congress acts swiftly, the impact on LTC pharmacies will be severe and many small LTC pharmacies—which represent more than 90% of the sector—could close their doors in 2026.
Part D Plans force LTC pharmacies to subsidize inadequate payment for their unique services with revenue from expensive brand-name drugs.
Drug pricing policy changes in the ARP and IRA will inadvertently break the LTC pharmacy payment model as LTC residents rely heavily on insulin, inhalers, and 8 of the first 10 drugs subject to Medicare negotiated prices. The problem will only get worse as more drugs added each year.
Part D payments to LTC pharmacies must reflect the actual cost of essential services. This starts by creating a new LTC pharmacy supply fee for all drugs subject to negotiated prices.
LTC pharmacy-specific PBM reform is needed to give CMS the direction and authority to level the contract negotiating playing field for LTC pharmacies, ensuring their ability to survive.
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.
