LTC pharmacies demand ‘sustainable’ payment model ahead of 2026 drug-pricing changes
By Kimberly Marselas
McKnight’s Long Term Care News
Many of the nation’s long-term care pharmacies are going to fall below “break-even” and may be forced out of business without additional support when drug-pricing policy changes kick in, sector advocates warned Wednesday.
The Senior Care Pharmacy Coalition is launching a new campaign for federal payment reform as the White House finalizes lower prices on 10 drugs widely used by Medicare beneficiaries and Congress toys with legislation that could loosen pharmacy benefit managers’ grip on most other US drug pricing.
Both efforts could have unintended effects on long-term care pharmacies, which have substantial dispensing costs associated with facility and patient services that commercial and independent pharmacies do not have.
“We have this precarious system when payers have been allowed to create a situation where they don’t pay for services,” said Alan Rosenbloom, president and CEO of the Senior Care Pharmacy Coalition. “The current perverse payment model was not something long-term care pharmacies ever wanted. It was handed to them because of the disproportionate negotiating power [PBMs] have.”
Read the full original article here.
Recent Posts
-
Pharmacy Group Wants CMS To Distinguish LTCs From Retailers Through RFI
Lauren Brensel // Inside Health Policy – September 16, 2026 A trade association representing long-term care pharmacies (LTCs) is hoping CMS will use an upcoming request for information to establish guidance on contracting issues like reimbursement rates and network adequacy standards that could differ for retail pharmacies. The group has met with CMS to discuss […]
-
SCPC Sends Reasonable & Relevant “Pre-Comment” Letter to CMS
The Senior Care Pharmacy Coalition (SCPC) submitted comments on the Calendar Year 2027 Home Health Prospective Payment System proposed rule, focusing on proposed changes to Medicare enrollment provisions. In its comments, SCPC applauded the work of CMS to address fraud and waste in the system while protecting services for those who need them most. SCPC urged CMS […]
-
SCPC Submits Second Round of Comments to Healthcare Advisory Committee
The Senior Care Pharmacy Coalition submitted comments yesterday to the Healthcare Advisory Committee (HAC). The HAC is a group of experts charged with delivering strategic recommendations directly to the HHS Secretary and CMS Administrator to improve how care is financed and delivered across Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), and the Health […]
Stay Connected
Get the latest news and updates on issues impacting the long-term care pharmacy community.