House Lawmakers Push Bipartisan IRA Fix To Boost LTC Pharmacy Pay

DATE: August 29, 2025

By Gabrielle Wanneh
InsideHealthPolicy

House Lawmakers Push Bipartisan IRA Fix To Boost LTC Pharmacy Pay
By Gabrielle Wanneh / August 28, 2025 at 7:17 PM

A bipartisan group of House lawmakers introduced legislation aimed at ensuring long-term care (LTC) pharmacies are paid an adequate supply fee to maintain patient access to prescription drugs for which prices are lowered through the Medicare drug price negotiation program, with the new maximum fair prices (MFPs) for the first group of selected drugs to take effect at the start of 2026.

The coalition responsible for the model legislation that inspired the new bill — the Senior Care Pharmacy Coalition — is now focused on finding a way to secure its passage before the end of the year, telling lawmakers unless Congress intervenes before Jan. 1, 2026, 60% of the coalition’s member LTC pharmacies will be forced to shut down multiple locations across the country.

The Preserving Patient Access to Long-Term Care Pharmacies Act seeks to mitigate the unintended negative impact of drug price negotiations on reimbursement for LTC pharmacies, for which Medicare Part D enrollees account for more than 80% of their business on average. Eight out of 10 of the inaugural group of drugs selected for price negotiations are heavily prescribed to patients in LTC facilities, and LTC pharmacies often lose money on most of the drugs they prescribe, while only making a profit on a small portion they fill, the coalition says.

The new bill would set up a $30 supply fee for plan year 2026 and a slightly higher fee amount for plan year 2027 to ensure continued access to the government-mandated LTC pharmacy services once the MFP for certain drugs go into effect. The supply fee would only apply to MFP drugs dispensed by LTC pharmacies.

The bill also directs the HHS secretary to impose a civil monetary penalty of at least $10,000 when a Part D plan sponsor or Medicare Advantage organization offering a prescription drug plan fails to pay the supply fee for a specified prescription.

The bill was introduced by House Reps. Beth Van Duyne (R-TX) and Brad Schneider (D-IL) and is co-sponsored by Reps. Buddy Carter (R-GA), Brian Jack (R-GA), Sharice Davids (D-KS) and Deborah Ross (D-NC).

“Long-term care pharmacies are a lifeline for millions of seniors and their families,” Van Duyne said in a statement Tuesday. “If we fail to act before January 1, 2026, many of these pharmacies will be forced to close their doors, leaving nursing homes, assisted living facilities, and vulnerable patients without the care they rely on. The Preserving Patient Access to Long-Term Care Pharmacies Act provides a critical fix now, before a crisis hits, so seniors can continue to access the safe, reliable pharmacy services they deserve.”

SCPC began reaching out to key congressional committees earlier this year with the initial proposed legislation that would eventually become the new House bill. The proposed legislation was modeled after a fix Congress implemented after passing the Medicare Modernization Act in 2003, which established the Part D program. The law had made changes to the Part B payment model that led to numerous doctors facing significant financial difficulties when it came to dispensing certain drugs, so lawmakers created a supply fee to rectify the issue.

SCPC President and CEO Alan Rosenbloom told Inside Health Policy the coalition hopes the Senate will introduce companion legislation next month, though there’s no guarantee of that happening. While Congress will need to prioritize passing spending legislation to fund the government in 2026 and reauthorize key federal programs upon returning in September, SCPC will be focused on building additional co-sponsors for the bill and positioning it to be considered for markup by the right committees, which would boost its likelihood of inclusion a year-end legislative package.

CMS recently posted an advisory notice encouraging Part D plan sponsors to ensure pharmacies receive adequate payment for drugs with MFPs once the new prices are effective starting next year. The Aug. 25 notice also reminds plan sponsors that plan enrollees residing in an LTC facility must be able to routinely receive their Part D benefits through the plan’s network of LTC pharmacies for sponsors to comply with CMS’ LTC convenient access standard.

But Rosenbloom says the advisory doesn’t require plans to comply with CMS’ requests regarding adequate pharmacy reimbursement for MFP drugs — making passage of the legislation critical.

In March, an SCPC survey of its member LTC pharmacies found that, in addition to 60% of pharmacies being at risk of having to close facilities across the country if Congress doesn’t pass the supply fee legislation before next year, 91% of SCPC member pharmacies would be forced to lay off pharmacy staff, 85% would be forced to limit essential services specific to LTC pharmacies, 82% would be forced to shift more costs to customers, and 56% would be challenged to dispense certain medications.