LTC Pharmacies Double Down On Call For PBM Contract Negotiation Reform

DATE: June 24, 2026

Lauren Brensel // Inside Health Policy – July 23, 2026

A group representing long-term care pharmacies is reminding policymakers of the negative impacts that result from problematic contract negotiations with pharmacy benefit managers, asking CMS to help alleviate pharmacies’ disputes with the three largest PBMs by embracing a series of reforms.

LTC pharmacy services like hand-delivering prescriptions, providing emergency access to medications and coordinating with nursing and assisted-living staff all become unstable when there are contracting issues with PBMs, the organization Senior Care Pharmacy Coalition wrote in a press release last week.

SCPC calls on CMS to keep PBMs accountable by implementing an audit review process and new requirements for open enrollment.

A source close to the issue told Inside Health Policy that, starting July, a group of LTC pharmacies are now considered out-of-network after the PBM Optum Rx canceled its contract mid-term with its Pharmacy Services Administrative Organization, which negotiates on behalf of independent or smaller pharmacies.

“These pharmacies are just terrified because they don’t know if they’re going to get paid for their services,” the source said. “These are not pharmacies that just stop providing medications, by the way. These are people that are in nursing homes and assisted living facilities that depend on these medications, and in many cases, are the only ones who have access to those drugs.”

SCPC asserts CMS has the authority to approve its suggestions without any push from Congress because of a spending law, the Consolidated Appropriations Act, that passed in February and directs the agency to define contract terms while regulating PBMs and Part D plans.

The recommendations from SCPC include incentivizing PBMs to submit contracts before open enrollment, establishing a minimum payment level for LTC pharmacies to offset low reimbursement rates and granting equal termination rights to both parties in the contracts.

Currently, some contracts require LTC facilities to give extensive notice of up to a year before being able to dissolve a contract, while PBMs can cancel a contract at any time.

SCPC met with CMS in January and first released its package of proposed reforms in February.

A high priority among SCPC’s asks is preventing PBMs from inputting late submissions that force LTC facilities to either accept a contract at face value or forgo coverage for its beneficiaries. At least one Part D plan or PBM failed to finalize its negotiations with “a number” of LTC pharmacies until January during contract years for 2025 and 2026, SCPC wrote.

Because of late contract negotiations, LTC pharmacies are also frequently and incorrectly mislabeled as out-of-network, increasing costs for beneficiaries. SCPC says this can be alleviated by allowing beneficiaries in skilled nursing facilities, intermediate care facilities or assisted living facilities to use a special enrollment period. An alternative fix, according to SCPC, would be mandating a plan must pay the LTC pharmacy at its usual rate until a contract is signed or a beneficiary switches to an in-network provider.

The additional call for contract negotiation reform comes after CMS filed a request for information last week looking for stakeholder feedback to further define PBM-affiliates and whether LTC pharmacies can be included in that category. 

Read the article in Inside Health Policy HERE.