Preserving Patient Access to Long-Term Care Pharmacies Act
- Sponsor
- Rep. Van Duyne, Beth [R-TX-24]
- Committees
- Ways and Means Committee (primary)
- Last action
- Aug 22, 2025
Bottom line
The bill provides temporary federal subsidies to long-term care pharmacies, channeled through Medicare Part D plans, to offset potential financial impacts from new drug pricing policies, while also commissioning a study for long-term solutions.
What it actually does
This bill amends the Social Security Act to temporarily establish a supply fee for long-term care pharmacies for plan years 2026 and 2027. Medicare Part D plans (PDP sponsors and MA organizations) would be required to pay these pharmacies a $30 fee (adjusted for inflation in 2027) for certain prescriptions dispensed to individuals eligible for maximum fair drug prices. The federal government would then fully reimburse these plans for the aggregate amount of fees paid. Additionally, the bill mandates a Government Accountability Office (GAO) study on the economic sustainability of long-term care pharmacies in the Medicare prescription drug program.
Proponents argue
Supporters argue this bill is crucial for maintaining the financial viability of long-term care pharmacies, which provide essential services to vulnerable Medicare beneficiaries. They contend that new drug pricing policies, particularly the Inflation Reduction Act's maximum fair price provisions, could disproportionately impact these pharmacies, leading to reduced access to care, especially in rural areas. The temporary fee and study provide necessary immediate relief and a path to a sustainable long-term solution.
Opponents contend
Critics might argue that this bill creates a new, unfunded federal expenditure without a clear long-term strategy, potentially adding to the national debt. They may question the necessity of a temporary fee if the underlying financial challenges are not fully understood or if the fee amount is not precisely calibrated to actual need. Some could also argue it sets a precedent for federal intervention in pharmacy reimbursement that could be expanded.
The bill is short and clearly written, making it accessible for a quick and informed read.
Section 2(a)
Long-Term Care Pharmacy Supply Fees
This provision mandates that Medicare Part D plans (both Prescription Drug Plans and MA-PD plans) pay a supply fee to long-term care pharmacies for specific prescriptions dispensed in 2026 and 2027. The fee starts at $30 in 2026 and is adjusted for inflation in 2027. This fee is in addition to other reimbursements and cannot reduce them. Failure to pay these fees can result in civil money penalties of at least $10,000 per instance. The fee applies to covered Part D drugs dispensed to individuals eligible for the 'maximum fair price' under other sections of the Social Security Act.
Supporters argue
Supporters argue this fee is essential to stabilize the financial position of long-term care pharmacies, particularly as they adapt to new drug pricing regulations. This ensures that these specialized pharmacies can continue to provide critical services, preventing disruptions in medication access for vulnerable residents in long-term care facilities.
Critics contend
Critics might contend that introducing a new, mandated fee, even if temporary, adds complexity to the Medicare Part D payment system. They may also question if a flat $30 fee is the most efficient or equitable way to address the diverse financial challenges faced by different long-term care pharmacies.
Tradeoffs
This provision balances the immediate need to support long-term care pharmacies against concerns about adding new costs and complexity to the Medicare program. It aims to provide targeted relief while acknowledging that a more permanent solution requires further study.
Section 2(b)
Repayment of Long-Term Pharmacy Supply Fees to Plans
This section ensures that Medicare Part D plans are fully reimbursed by the Secretary of Health and Human Services for the aggregate amount of supply fees they pay to long-term care pharmacies during plan years 2026 and 2027. These subsidies are to be provided in addition to other payments to the plans, no later than 18 months after the end of the applicable plan year.
Section 2(c)
GAO Study and Report on Long-Term Care Pharmacy Sustainability
This provision directs the Comptroller General of the United States (GAO) to conduct a study and submit a report to Congress within 12 months of the bill's enactment. The study will analyze the economic sustainability of long-term care pharmacies participating in the Medicare prescription drug program. It will examine payment structures (ingredient costs, dispensing fees), compliance costs, and payment changes over the preceding five years. The report must also include recommendations for creating a sustainable payment system to ensure uninterrupted access to long-term care pharmacy services, particularly in rural markets.
The supply fee specifically applies to 'specified prescriptions' dispensed to an 'applicable maximum fair price eligible individual' at the 'maximum fair price'. These terms are defined by cross-reference to sections 1191 and 1193 of the Social Security Act.
Section 2(a)(iii)(I) and (V)
Why it matters:This is standard legislative practice to avoid reprinting lengthy definitions or entire sections of existing law. However, it makes the bill's precise scope less immediately obvious to a casual reader.
Case for: Supporters would argue that this precise targeting ensures the financial relief is directed exactly where it's needed most – to pharmacies dispensing drugs affected by the Inflation Reduction Act's price negotiation provisions, which are the source of the anticipated financial strain.
Case against: Critics might argue that by relying on complex external definitions, the bill's true impact and target population are obscured, making it harder for stakeholders and the public to fully grasp who benefits and under what exact circumstances.
Estimated impact: This linkage means the supply fee is not a general payment for all prescriptions but is specifically tied to drugs subject to federal price negotiation, limiting its scope to a subset of long-term care pharmacy operations.
The Secretary shall impose a civil money penalty of 'not less than $10,000' for each failure of a PDP sponsor or MA organization to pay a supply fee.
Section 2(a)(ii)(I)
Why it matters:This is standard legislative drafting for enforcement mechanisms. The specific amount is a detail of implementation rather than the primary policy.
Case for: Proponents would argue that a substantial minimum penalty ensures strong compliance from Medicare Part D plans, guaranteeing that the intended financial relief reaches long-term care pharmacies without undue delays or disputes.
Case against: No direct opposition, but some might argue that a fixed minimum penalty, regardless of the scale or context of the failure, could be overly punitive in certain circumstances.
Estimated impact: This provision ensures robust enforcement of the supply fee, making it highly likely that plans will comply with the payment requirement.