Preserving Patient Access to Long-Term Care Pharmacies Act
Preserving Patient Access to Long-Term Care Pharmacies Act would temporarily create and pay a new supply fee to long-term care (LTC) pharmacies for each specified prescription dispensed to Medicare enrollees in 2026 and 2027. The fee would be paid by prescription drug plan (PDP) sponsors and Medicare Advantage with Part D (MA-PD) plans, in addition to existing reimbursements, and would not reduce other payments to LTC pharmacies. If sponsors fail to pay the fee, they could face civil penalties. The bill also requires the federal government to reimburse sponsors for the aggregate amount of these fees after the end of each plan year, and it mandating a GAO study within a year of enactment to assess the sustainability of LTC pharmacies’ participation in Medicare Part D. The goal is to ensure LTC pharmacies remain accessible to Medicare beneficiaries, including in rural areas, during the covered years.
Key Points
- 1Temporary LTC pharmacy supply fees (2026 and 2027): For each specified prescription dispensed by a LTC pharmacy to an enrollee, PDP sponsors and MA-O plans must pay a per-prescription supply fee of $30 for 2026 and an amount for 2027 equal to the prior year’s fee increased by the statute’s specified annual percent increase.
- 2Payment in addition to other reimbursements: The supply fee is paid alongside, and must not reduce, existing reimbursements such as ingredient costs, dispensing fees, or other negotiated payments.
- 3Enforcement and penalties: If a sponsor/MA-O fails to pay the supply fee as required, the Secretary may impose a civil money penalty of at least $10,000 per failure, with penalties administered under the general framework for civil penalties (similar to how other enforcement provisions operate under 1128A).
- 4Subsidies to sponsors: For plan years 2026 and 2027, the Secretary must provide subsidies to PDP sponsors/MA-O plans equal to the total supply fees they paid to LTC pharmacies, with payment due no later than 18 months after the end of the applicable plan year.
- 5GAO study and report: Within 12 months after enactment, the Comptroller General must study the economic sustainability of LTC pharmacies’ participation in Medicare Part D, analyzing payments (ingredient costs, dispensing fees), compliance costs, and changes in payments over the prior five years, and provide recommendations to maintain uninterrupted access to LTC pharmacy services, especially in rural markets.