Letter to the Editor: Inquirer readers on billing by long-term care pharmacies
By Rob Franklin | Published December 11, 2025 in The Philadelphia Enquirer
Well-meaning policy
If you walk into any nursing home in the southeastern corner of the commonwealth, you’ll find a highly choreographed system of long-term care (LTC) pharmacies humming along that help keep older Pennsylvanians safe and are the backbone of patient care.
But this system is just months away from a potential collapse. Unless the Trump administration or Congress takes action now, on Jan. 1, a new policy will devastate LTC pharmacies that serve senior living facilities and nursing homes.
Passed during the Biden administration, the Inflation Reduction Act allowed the federal government to negotiate with drug companies to determine “maximum fair prices” on certain expensive brand-name drugs for Medicare Part D beneficiaries — a policy designed to help seniors afford medications.
But there’s a problem: The law is about to bankrupt the very pharmacies these seniors depend on to stay alive.
By setting “maximum fair prices” on certain brand-name drugs, the policy significantly reduces the reimbursement rates LTC pharmacies receive.
This price change will have rippling effects on all facilities that depend on the services of LTC pharmacies, including the 200,000 Medicare Part D beneficiaries over age 65 who have long-term care needs.
The Trump administration can act via an executive order to keep LTC pharmacies operational by delaying or modifying the new drug pricing until a sustainable payment model is identified.
Simultaneously, Congress must pass the bipartisan Preserving Patient Access to Long-Term Care Pharmacies Act (HR 5031). This legislation would establish a temporary $30 supply fee for each prescription filled under the new negotiated prices — a modest investment that would keep pharmacies solvent through 2027.
We can’t afford to look the other way — our seniors deserve a system that supports them, not one that collapses under the weight of well-meaning policy.
Read the full article on The Philadelphia Enquirer here
Recent Posts
-
NCPA Advocates for Medicare Drug Price Negotiation Program Overhaul Due to Pharmacy Cash Flow
With its initial rollout beginning in 2026, the Medicare Drug Price Negotiation Program has caused significant strain on the cash flow of independent pharmacies.
The National Community Pharmacists Association (NCPA) is sounding the alarm over the federal government’s implementation of the Medicare Drug Price Negotiation Program (MDPNP) after a recent survey of its members revealed significant financial distress, according to a news release.
-
Pharmacies To Face Low Cash Flow For MFP Drugs Until Fixes Emerge
A bill introduced last year aiming to ensure long-term care (LTC) pharmacies can continue to supply and dispense Medicare Part D drugs despite lower prices resulting from the price negotiation program will need to be tweaked to ensure the intended relief is retroactive, according to Alan Rosenbloom, executive director of the Senior Care Pharmacy Coalition (SCPC).
-
SCPC Applauds Inclusion of PBM Reform in Recent Spending Package Approved by U.S. House & Senate
The Senior Care Pharmacy Coalition (SCPC), the leading voice for the nation’s long-term care (LTC) pharmacy community, released the following statement about the passage of PBM reform: “SCPC applauds the passage of bipartisan pharmacy benefit manager (PBM) reform legislation by both the U.S. House and Senate, marking a significant step toward greater transparency, accountability, and fairness in the prescription drug marketplace. These […]
Stay in the Know
Get the latest news and updates on issues impacting the long-term pharmacy community.