New Avalere Health Study: Long Term Care (LTC) Pharmacy Sector Plays Key, Growing Role in U.S. Seniors’ Care as New Payment, Delivery Models Gain Prevalence

DATE: October 8, 2015

Major Structural, Regulatory and Legal Differences Between LTC and Retail Pharmacies Detailed; More Transparent Drug Pricing Can Help LTC Pharmacies Sustain High Quality SNF, ALF Patient Care

Washington, DC – A new Avalere Health study of the nation’s growing long term care (LTC) pharmacy sector – the most detailed analysis since Medicare Part D was implemented in 2006 – finds LTC pharmacies playing a greater role in seniors’ clinical care as new health payment and delivery models such as Accountable Care Organizations (ACOs), bundled payments and value-based purchasing proliferate amid a rapidly changing healthcare marketplace.

The study, entitled “Long-Term Care Pharmacy: The Evolving Marketplace and Emerging Policy Issues,” was conducted for the Senior Care Pharmacy Coalition (SCPC), and also suggests that a more transparent, streamlined drug pricing and distribution process can help sustain the beneficial LTC pharmacy clinical services that advance high quality care and Medicare cost-savings.

“As the launch of the SCPC was an important milestone for our sector in 2014, our release of this benchmark report in 2015 demonstrates independent LTC pharmacies, our patients and our business partners will continue to benefit from a robust, sector-specific advocacy and educational effort in which facts, data and metrics demonstrate the significant added value of medication therapy management and unique, clinical services we provide,” stated Michael Bronfein, Chairman of the SCPC, and co-founder of the Baltimore, MD-based NeighborCare and Remedi SeniorCare.

“With this report, and another to soon be released related to Maximum Allowable Cost (MAC) pricing, we will continue to focus not just upon the challenges facing independent LTC pharmacies and our patients, but also putting forward the bipartisan policy solutions to address them,” Bronfein continued. “Moreover, we believe it is time to finally initiate an objective, constructive, data-informed policy discussion on how best to meet the interests and health needs of elderly consumers in a volatile, excessively opaque drug pricing marketplace.”

Observes the Avalere Health report on more transparent drug pricing: “To preserve choice, and to ensure that elderly SNF and ALF patients continue to receive the LTC pharmacy clinical services that help advance high-quality patient care and cost-savings objectives, policymakers should consider how to address the unique needs and roles of LTC pharmacies as they seek to streamline, standardize and make more transparent the drug pricing and distribution process.”

In addition to noting LTC pharmacies are distinctly different than retail pharmacies — with significantly greater clinical, operational, legal and regulatory requirements resulting in higher costs to dispense — the 32-page study also details how LTCPs play an essential, unique role in patient care teams; that the typical skilled nursing facility (SNF) patient receives 8 to 10 different medications each day; and that LTCPs serve a crucial role in the care continuum by ensuring seniors’ pharmaceutical needs are met, consultative services are performed and patient-specific clinical intervention is carried-out as needed.

Other key sections of the study include an Overview of LTC Pharmacies and their national footprint; Understanding the Differences Between LTC and Retail Pharmacies; State of the LTC Pharmacy Sector and the most common conditions for which LTC Pharmacies dispense prescriptions; LTC Pharmacy Sector Consolidation and their relationship with prescription drug plans (PDPs) and pharmacy benefit managers (PBMs); LTC Pharmacy Policy Issues and Challenges including MAC pricing, dispensing fees and short-cycle dispensing, FDA repackaging guidance and the shift to value-based payment and other delivery models. The conclusion details the issues policymakers should consider to improve the viability and strength of the LTC pharmacy sector as it assumes a larger role in the broader spectrum of care.

Alan G. Rosenbloom, President and CEO of SCPC, concluded: “Independent LTC pharmacists provide a unique set of capabilities to serve an increasingly vulnerable patient population. As baby boomers age, the population over 85 will grow by nearly 90 percent over the next 20 years, and these seniors’ need for medications and related consultative services will grow. Independent LTC pharmacies can be increasingly integral to optimizing care outcomes and boosting spending efficiencies — and this new study will help us to continue making this case on Capitol Hill and with the broader national healthcare community.”

Rosenbloom said SCPC would release subsequent news releases over the next several months corresponding to the wide variety of issues and topics addressed in this LTC pharmacy sector report.