Bipartisan bill proposes fee to support pharmacies in care homes
TL/DR –
The US federal lawmakers have proposed a bill, HR 5031, to implement a $30 supply fee per Medicare Part D prescription in 2026 and 2027 to help long-term care pharmacies facing major revenue losses. The bill comes in response to the financial impact caused by the implementation of negotiated prices on 10 commonly prescribed medications. The proposed supply fee would be in addition to existing payments for drug costs and dispensing fees, and the federal government would reimburse Medicare plans for supply fees after each plan year.
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Legislators Move to Support Long-Term Care Pharmacies Faced with Revenue Losses
With the upcoming implementation of negotiated prices on ten frequently prescribed drugs which is predicted to cause major revenue losses for long-term care pharmacies, federal lawmakers have proposed the introduction of a supply fee. This fee is designed to aid these pharmacies in maintaining their operations.
The proposed legislation, known as HR 5031 or the Preserving Patient Access to Long-Term Pharmacies Act, seeks to establish a $30 fee for each Medicare Part D prescription in the years 2026 and 2027. The bill’s sponsor, Rep. Beth Van Duyne (R-TX), explained in a press release that the legislation is intended to allow long-term care pharmacies to continue serving residents of nursing homes and assisted living facilities by setting up a temporary supply fee for negotiated Part D drugs.
Long-term care pharmacies have been disproportionately impacted by the Inflation Reduction Act, as the medications now priced lower account for 80% of their business on average. These pharmacies have historically relied on the revenue from these medications to cover the lower payments received for generic medications and other long-term care expenses such as specialty packaging and care management.
According to the Senior Care Pharmacy Coalition, the average long-term care pharmacy customer requires 13 different prescription medications. The Coalition has expressed its support for the proposed legislation, which is co-sponsored by multiple representatives including Brad Schneider (D-IL), Earl “Buddy” Carter (R-GA), Sharice Davids (D-KS), Brian Jack (R-GA) and Deborah Ross (D-NC).
The President and CEO of SCPC, Alan Rosenbloom, commended Rep. Van Duyne and Rep. Schneider for their efforts to address this urgent issue facing long-term care pharmacies. He stated that SCPC’s over 400 pharmacy members and the millions of patients they serve nationwide endorse HR 5031, a legislation hoping to prevent many pharmacies from being forced to close their doors in 2026.
The bill also proposes an increase in the supply fee in 2027 due to inflation and highlights that this fee would be in addition to existing payments for drug costs and dispensing fees. The bill’s authors further note that insurance and prescription plans cannot decrease other payments due to this fee.
Under the proposed legislation, supply fees would be reimbursed to Medicare plans by the federal government after each plan year. It is yet to be determined how much this coverage will cost, although it is expected that the government will save $98.5 billion over ten years through Medicare drug-price negotiations. Prices for an additional 15 drugs are currently under consideration for 2027.
Medicare drug plans (Part D or Medicare Advantage Part D) that fail to pay the fee could face penalties of up to $10,000 per violation as per the provisions of the bill. The bill also mandates the US Government Accountability Office to examine the economic viability of long-term care pharmacy participation in Medicare and propose policy recommendations to preserve access, particularly in rural regions.
A survey conducted earlier this year revealed that without changes to the drug-pricing efforts, 85% of long-term care pharmacies serving assisted living communities and nursing homes would restrict essential services and 60% would shut down locations.
Chad Worz, PharmD, the executive director of the American Society of Consultant Pharmacists, emphasized the challenges that long-term care pharmacies will face in maintaining services and operations under the new payment models as the Medicare Drug Price Negotiation Programs begin implementation. Worz expressed his appreciation for Congress joining their efforts to ensure the continued access of long-term care residents to pharmacy services that are vital to their quality of life.
Rep. Earl “Buddy” Carter, a pharmacist who once served assisted living communities, nursing homes and hospice programs, stated that the bill would ensure access to essential medication for more than two million older adults.
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