Bring it on home: Obstacles and opportunities in bringing long-term care pharmacy services to Medicare beneficiaries living at home

DATE: May 5, 2022

By Alan Rosenbloom

As anyone who has been prescribed medication knows, pharmacies play a crucial role in our health care system. This is especially true for older people, since their reliance on medications to treat their overall health care needs increases. While younger, healthier people can turn to a local retail pharmacist, people with medically complex or chronic conditions often need more from their pharmacy. Long-term care pharmacies exist to take care of this population and offer a more tailored approach to dispensing medication. This is done through regular medication review to decrease the number of prescriptions, patient and caregiver education, and specialized medication packaging, among other services.

Most long-term care pharmacies serve patients residing in long-term care facilities like nursing homes. People in these facilities need long-term care because they have trouble performing activities of daily living like bathing, eating, or dressing without assistance. They also have significant chronic health care needs, and rely on an average of 12 prescription drugs each day. For those living in facilities, long-term care pharmacies are available 24/7/365 to actively manage medication, handle emergencies, and coordinate overall care with the patient’s health care team. 

Like their one million Medicare beneficiary peers residing in facilities, Medicare beneficiaries with long-term care needs living at home also have trouble with daily activities and suffer from chronic health care conditions that require more medication and care management. They are just as reliant on prescription drugs as those in long-term care facilities. However, services and support such as long-term care pharmacy are not available for the three million Medicare beneficiaries who need long-term care but are living at home. 

Make no mistake, long-term care pharmacies could serve people who live at home or in other community settings like low-income senior housing or retirement communities, but the U.S. Congress and the Centers for Medicare & Medicaid Services (CMS) must adopt new policies and remove barriers if such services are expanded beyond facilities. 

Recent research by ATI Advisory and the Senior Care Pharmacy Coalition found that existing policy is biased toward institutional care, leaving an increasing number of older Americans who choose to live at home without the support they deserve. The impact of these barriers to equitable medication support cannot be overstated. About 75% of Medicare beneficiaries with long-term care needs live at home or in the community and on average they require 14 prescriptions per year. 

One major issue is the failure of federal policy to recognize long-term care pharmacy as a defined entity. Despite the irreplaceable role of long-term care pharmacies in communities across the country, no federal statutory or regulatory definition of long-term care pharmacy exists. Instead, long-term care pharmacies must navigate a patchwork of vague, inconsistent provisions. These conflicting and confusing regulatory obligations threaten patient care by disrupting the clinical services, medication management and other activities needed to improve patient outcomes. 

Current reimbursement does not reflect the cost of delivering services in the home, impeding access to long-term care pharmacies. When policy treats long-term care pharmacies only as a medication delivery service, it minimizes the key role long-term care pharmacies play in offering high-touch services and essential care required by people with long-term care needs. 

In most cases, payers do not pay for LTC pharmacy services at home. Something needs to change across the system. Similarly, existing federal policy does not explicitly recognize LTC pharmacy services as among the home and community-based services needed to afford equitable access to all individuals who need LTC care, wherever they live. To start to address these obstacles, policymakers should pass the Long-Term Care Pharmacy Definition Act of 2021 this year to allow long-term care pharmacies to focus on providing high-quality, essential care to people rather than interpreting conflicting regulations. 

Similarly, updated guidance from CMS on beneficiary access to LTC pharmacy services at home and systemic application of the existing Medicare process to determine which Medicare beneficiaries living at home need long-term care would be significant steps toward maximizing equitable access for all Americans.

Health care policy must catch up to the reality: more people who need long-term care live at home than in facilities, and more people than ever before are aging in place and choosing to live in their communities, and they deserve high-quality care and services wherever they choose to live.

Alan Rosenbloom is the president and CEO of the Senior Care Pharmacy Coalition, a non-profit advocacy organization representing the interests of long-term care pharmacies based in Washington, D.C.