Long-Term Care Pharmacies Say Negotiation Hurts Them Without PBM Reform

DATE: August 30, 2023

By Luke Zarzecki
Inside Health Policy

Long-term care pharmacies say the kick-off of Medicare drug price negotiation Tuesday (Aug. 29), while well-intentioned, will inadvertently hurt them and their patients unless policy makers also move forward on pharmacy benefit manager and Part D payment reforms.

“Long term care pharmacies are likely to be collateral damage,” Alan Rosenbloom, president and CEO of the Senior Care Pharmacy Coalition, told Inside Health Policy.

Eight of the 10 medications included on the Part D price negotiation list unveiled Tuesday are heavily prescribed to patients in long-term care facilities. Those pharmacies lose money on most of the medicine they prescribe and only make a profit on a small portion they fill, the coalition said.

Rosenbloom cheered on paying less for drugs both for consumers and the government, but said more action is needed. He said pharmacy benefit managers and insurance companies are primarily responsible for high drug costs and policy changes need to be enacted.

With the new drug negotiations, he said if PBMs and insurance companies don’t add alternatives to their formularies, that could make long-term care pharmacies “existentially threatened” and leave some people in long-term care facilities without medication.

That’s the worst-case scenario, he said. To avoid it, SCPC calls for federal regulators and lawmakers to act.

Read the full original article here.