Long-Term Care Pharmacy: The Evolving Marketplace and Emerging Policy Issues
A new Avalere Health study of the nation’s growing long term care pharmacy sector shows LTC pharmacies playing a greater role in seniors’ clinical care as new health payment and delivery models such as Accountable Care Organizations (ACOs), bundled payments and value-based purchasing proliferate amid a rapidly changing healthcare marketplace.
The study is entitled “Long-Term Care Pharmacy: The Evolving Marketplace and Emerging Policy Issues” was conducted for SCPC. It also suggests that a more transparent, streamlined drug pricing and distribution process can help sustain the beneficial LTC pharmacy clinical services that advance high quality care and Medicare cost-savings.
Amid growing scrutiny of Pharmacy Benefit Manager (PBM) pricing practices, along with increasing concern from Congress, regulators and consumer groups about the rapid pace and broader implications of U.S. health sector mergers and consolidations, the Senior Care Pharmacy Coalition also released a new analysis of long term care (LTC) pharmacy transaction data.
The analysis, sponsored by the SCPC and conducted by Avalere Health, reveals increasing reimbursement inequities for LTC pharmacies driven by Maximum Allowable Cost (MAC) pricing methodologies, which are used to pay for a substantial majority of drugs dispensed by independent LTC pharmacies to patients in LTC facilities.