Bill would fix drug-negotiation pricing flaw that undercuts LTC pharmacists’ viability

DATE: August 29, 2025

By Kimberly Marselas
McKnight’s Long-Term Care News

Lawmakers have proposed a supply fee to bolster long-term care pharmacies facing major revenue losses with the implementation of negotiated prices on 10 commonly prescribed medications Jan. 1.

The Preserving Patient Access to Long-Term Pharmacies Act establishes a $30 per Medicare Part D prescription in 2026 and 2027.

The Inflation Reduction Act hit LTC pharmacies harder than others because eight of the 10 drugs getting lower prices make up 80% of their business on average. LTC pharmacy groups have previously told McKnight’s Long-Term Care News they depend on revenues from those drugs to offset lower payments for generic medications, as well as the cost of other added LTC costs — including speciality packaging and care management.

The average LTC pharmacy patient is on 13 different prescription medications, the Senior Care Pharmacy Coalition noted Wednesday in backing the legislation introduced by Reps. Beth Van Duyne (R-TX), Brad Schneider (D-IL), Buddy Carter (R-GA), Sharice Davids (D-KS) and Deborah Ross (D-NC).

“SCPC’s 400-plus pharmacy members and the millions of patients we serve across the country stand in support of HR 5031, which aims to provide a critical LTC pharmacy fix before many pharmacies are forced to close their doors in 2026,” said Alan Rosenbloom, SCPC’s president and CEO. “We commend Rep. Van Duyne and Rep. Schneider for stepping up to address a problem LTC pharmacies urgently need to solve to protect essential LTC care and services, like 

medication management, 24/7 support, emergency delivery, and care coordination.” 

The proposed supply fee could increase in 2027 due to inflation. It also would come in addition to existing payments for drug costs and dispensing fees, and authors noted that insurance and prescription plans “cannot offset or reduce other payments because of this fee.”

Under the proposal, the federal government would reimburse Medicare plans for supply fees after each plan year. No cost estimate was given for that coverage, but the government is expected to save $98.5 billion over a decade through Medicare drug-price negotiations. Prices for an additional 15 drugs are currently under discussion for 2027.

The bill includes penalties of up to $10,000 per violation for Medicare drug plans (Part D or Medicare Advantage Part D) that fail to pay the fee.

Sustainability questions

The bill also directs the Government Accountability Office to study the economic sustainability of LTC pharmacy participation in Medicare and to make policy recommendations to preserve access, especially in rural areas.

A survey earlier this year revealed 85% of long-term care pharmacies serving nursing homes and assisted living facilities would limit essential services and 60% would close locations without changes to the drug-pricing efforts.

“As the implementation date for the Medicare Drug Price Negotiation Programs approaches, it is becoming clearer and clearer that many long-term care pharmacies will face significant challenges maintaining services and operations under these new payment models,” Chad Worz, PharmD, executive director of the American Society of Consultant Pharmacists.

“At ASCP, we have been working with plans, payers, PBMs and manufacturers to ensure continued access to care for our patients,” he added. “With this bill, Congress has joined our fight to ensure that long-term care residents maintain the pharmacy services that support their continued quality of life.”
Rep. Carter, a pharmacist who once served nursing homes, said the bill would ensure access to essential medication for more than two million seniors.